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Farhan SY, Abraha D, Edyedu I, Molen SF, Mauricio W, Odong SO, Mugeni M, Muhumuza J. Factors associated with early inhospital adverse outcome following surgery for acute appendicitis in Uganda: a multicenter cohort. Perioper Med (Lond) 2024; 13:51. [PMID: 38831345 PMCID: PMC11149220 DOI: 10.1186/s13741-024-00412-9] [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: 10/30/2023] [Accepted: 05/31/2024] [Indexed: 06/05/2024] Open
Abstract
INTRODUCTION Surgery for acute appendicitis has been associated with significant morbidity. This study aimed to determine the factors associated with early inhospital adverse outcomes following surgery for acute appendicitis in Uganda. METHODS This was a multicentre, prospective cohort in which early inhospital outcome following surgery for acute appendicitis was assessed at 4 regional referral hospitals in Uganda. The occurrence of complications during the admission period was documented as well as the length of hospital stay. Factors associated with adverse outcomes were determined using Poisson regression. RESULTS Of the 102 patients who underwent surgery for acute appendicitis, the majority were males 79(77.5%) with a mean age of 23.8(SD = 12.5) years. The perforated appendix was seen in 26 (25.5%) patients. Post-operative complications occurred in 21(20.6%) with the commonest being surgical site infection in 19(18.6%) patients. The median length of hospital stay was 3(IQR = 3-4) days with 43(42.2%) staying in hospital for more than 3 days. The presence of anemia (Hb < 8) (aRR = 1.376, CI = 1.159-1.634, P = < 0.001) and having a perforated appendix (aRR = 1.263, CI = 1.026-1.555, P = 0.027) were independently associated with occurrence of complications while being HIV positive (aRR = 1.379, CI = 1.105-1.721, P = 0.005) and having a perforated appendix (aRR = 1.258, CI = 1.019-1.554, P = 0.033) were independently associated with prolonged hospital stay. CONCLUSION Community education about early presentation is still required in order to reduce the number of patients that present late which should, in turn, reduce the risk of complications and length of hospital stay.
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Affiliation(s)
- Sharif Yusuf Farhan
- Department of Surgery, Faculty of Clinical Medicine and Dentistry, Kampala International University Western Campus, Ishaka-Bushenyi, Uganda.
| | - Demoz Abraha
- Department of Surgery, Faculty of Clinical Medicine and Dentistry, Kampala International University Western Campus, Ishaka-Bushenyi, Uganda
| | - Isaac Edyedu
- Department of Surgery, Faculty of Clinical Medicine and Dentistry, Kampala International University Western Campus, Ishaka-Bushenyi, Uganda
| | - Selamo Fabrice Molen
- Department of Surgery, Faculty of Clinical Medicine and Dentistry, Kampala International University Western Campus, Ishaka-Bushenyi, Uganda
| | - William Mauricio
- Department of Surgery, Faculty of Clinical Medicine and Dentistry, Kampala International University Western Campus, Ishaka-Bushenyi, Uganda
| | - Samuel Oledo Odong
- Department of Surgery, Faculty of Clinical Medicine and Dentistry, Kampala International University Western Campus, Ishaka-Bushenyi, Uganda
| | - Michael Mugeni
- Department of Surgery, Faculty of Clinical Medicine and Dentistry, Kampala International University Western Campus, Ishaka-Bushenyi, Uganda
| | - Joshua Muhumuza
- Department of Surgery, Faculty of Clinical Medicine and Dentistry, Kampala International University Western Campus, Ishaka-Bushenyi, Uganda.
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Basher MOS, Ahmed AA, Hamza AA. Mean platelet volume and total white blood cells as diagnostic biomarkers for acute appendicitis at Omdurman military hospital: a cross-sectional study - 2021. BMC Gastroenterol 2023; 23:444. [PMID: 38104067 PMCID: PMC10725578 DOI: 10.1186/s12876-023-03091-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Accepted: 12/12/2023] [Indexed: 12/19/2023] Open
Abstract
BACKGROUND Acute appendicitis (AA) is among the most common nontraumatic indications for emergent abdominal surgical procedures. However, accurately diagnosing all cases can be challenging, physical examination, biochemical markers, and imaging techniques can sometimes be insufficient. This study aimed to (a) compare the mean platelet volume (MPV) and total white blood cell count (TWBCs) in patients with or without histological evidence of an inflamed appendix and (b) determine the positive predictive value, negative predictive value, sensitivity, and specificity of both MPV and TWBCs as diagnostic biomarkers in the diagnosis of AA. We conducted this research at Omdurman Military Hospital, focusing on patients who presented with symptoms suggestive of AA. MATERIALS AND METHODS An analytical cross-sectional study conducted at Omdurman Military Hospital from December 2020 - December 2021. The study population was patients who presented to our emergency department with symptoms and signs suggestive of AA. Participants were patients operated on as cases of AA. Data variables included sociodemographic characteristics, clinical presentations, intraoperative appendix macroscopic findings, preoperative MPV and total white blood cell count (TWBCs), and postoperative histopathological findings. RESULTS A total of 106 patients were included in this study, with 75 (68.2%) males; half were 10-19 years old. Sixty-three patients (57.3%) had low (< 7.5 fL) MPV, whereas 47 (42.7%) had normal values. Comparing MPV to total white blood cells (TWBCs) revealed that MPV was more sensitive (84.6%) and specific (90%) than TWBCs during the first 24 h of inflammation. However, the TWBCs were more sensitive (97.2%) but less specific (94.7% vs. 100%) after 24 h of onset. CONCLUSION In this study, MPV was lower in patients with AA, while there was an increase in TWBCs. The high sensitivity and specificity of TWBCs and MPV indicated that they form a promising diagnostic marker for AA.
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Affiliation(s)
| | - Ahmed Abdelfattah Ahmed
- Department of General Surgery, Omdurman Military Hospital, Alneelain University, Khartoum, Sudan
| | - Aamir Abdullahi Hamza
- Department of General Surgery, Omdurman Teaching Hospital, College of Medicine, University of Bahri, Khartoum, Sudan
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Louw J, McCaul M, English R, Nyasulu PS, Davies J, Fourie C, Jassat J, Chu KM. Factors Contributing to Delays to Accessing Appendectomy in Low- and Middle-Income Countries: A Scoping Review. World J Surg 2023; 47:3060-3069. [PMID: 37747549 PMCID: PMC10694117 DOI: 10.1007/s00268-023-07183-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/29/2023] [Indexed: 09/26/2023]
Abstract
BACKGROUND Appendicitis is one of the most common emergency surgical conditions worldwide. Delays in accessing appendectomy can lead to complications. Evidence on these delays in low- and middle-income countries (LMICs) is lacking. The aim of this review was to identify and synthesise the available evidence on delays to accessing appendectomy in LMICs. METHODS This scoping review followed the Preferred Reporting Items for Systematic Reviews and Meta-analysis Extension for Scoping Reviews framework. The delays and their interconnectivity in LMICs were synthesised and interpreted using the Three Delays framework. We reviewed Africa Wide EBSCOhost, PubMed-Medline, Scopus, Web of Science, African Journals Online (AJOL), and Bioline databases. RESULTS Our search identified 21 893 studies, of which 78 were included in the final analysis. All of the studies were quantitative. Fifty per cent of the studies included all three types of delays. Delays in seeking care were influenced by a lack of awareness of appendicitis symptoms, and the use of self and alternative medication, which could be linked to delays in receiving care, and the barrier refusal of medical treatment due to fear. Financial concerns were a barrier observed throughout the care pathway. CONCLUSION This review highlighted the need for additional studies on delays to accessing appendectomy in additional LMICs. Our review demonstrates that in LMICs, persons seeking appendectomy present late to health-care facilities due to several patient-related factors. After reaching a health-care facility, accessing appendectomy can further be delayed owing to a lack of adequate hospital resources.
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Affiliation(s)
- Johnelize Louw
- Centre for Global Surgery, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa.
- Division of Health Systems and Public Health, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa.
| | - M McCaul
- Division of Epidemiology and Biostatistics, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - R English
- Division of Health Systems and Public Health, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - P S Nyasulu
- Division of Epidemiology and Biostatistics, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
- Division of Epidemiology and Biostatistics, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - J Davies
- Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - C Fourie
- Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - J Jassat
- Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - K M Chu
- Centre for Global Surgery, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
- Department of Surgery, University of Botswana, Plot 4775 Notwane Rd, Gaborone, Botswana
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Afridi MA, Khan I, Khalid MM, Ullah N. Combined clinical accuracy of inflammatory markers and ultrasound for the diagnosis of acute appendicitis. ULTRASOUND (LEEDS, ENGLAND) 2023; 31:266-272. [PMID: 37929253 PMCID: PMC10621497 DOI: 10.1177/1742271x221147733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Accepted: 11/03/2022] [Indexed: 11/07/2023]
Abstract
Introduction Acute appendicitis is traditionally a clinical diagnosis where there are a range of diagnostic accuracies reported. The role of ultrasound is to improve specificity and decrease negative appendicectomy rate. It is a simple, non-invasive, easily available technique.The purpose of this study is to determine the diagnostic accuracy of an ultrasound in combination with total leukocyte count, neutrophil percentage and C-reactive protein in diagnosing acute appendicitis. Methods This study includes consecutive sampling of suspected patients from January 2021 to February 2022 with the approval of the ethical and research committee. Clinical and personal demographics and characteristics of patients were collected, including age, gender, symptoms and clinical signs. Ultrasonographic findings of fluid-filled appendiceal diameter of more than 6 mm, periappendiceal echogenic mesentry and an appendicolith were primary positive features. Laboratory inflammatory markers of total leukocyte count, neutrophil percentage and C-reactive protein were also included. Results A total of 250 patients were included with a mean age of 25 ± 9.79 years. Total leukocyte count showed the highest sensitivity (77.68%), followed by neutrophil percentage (69.96%), C-reactive protein (67.10%) and ultrasound (62.96%). While ultrasound had the best specificity (70.59%), it was followed by C-reactive protein and total leukocyte count (64.71%) and neutrophil percentage (58.82%), respectively. The sensitivity and specificity (99% and 98%) increased significantly when all four tests were combined. Conclusions Clinical assessment with laboratory inflammatory markers and ultrasound improves the early diagnosis of appendicitis and decreases the false-positive appendicitis diagnosis, hence saving surgeons' time and relieving patients from unnecessary appendicectomies.
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Affiliation(s)
- Muhammad Arif Afridi
- University Institute of Radiological Sciences & Medical Imaging Technology (UIRSMIT), The University of Lahore, Lahore, Pakistan
| | - Imran Khan
- Khyber Medical University, Peshawar, Pakistan
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Basukala S, Thapa N, Bhusal U, Shrestha O, Karki S, Regmi SK, Shah KB, Shah A. Comparison of outcomes of open and laparoscopic appendectomy: A retrospective cohort study. Health Sci Rep 2023; 6:e1483. [PMID: 37547357 PMCID: PMC10400783 DOI: 10.1002/hsr2.1483] [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] [Received: 04/11/2023] [Revised: 07/21/2023] [Accepted: 07/24/2023] [Indexed: 08/08/2023] Open
Abstract
Background Open appendectomy has been the conventional choice of treatment for acute appendicitis. However, nowadays laparoscopic approach is emerging for the benefits it provides, like lesser postoperative pain and lesser duration of hospital stay, but at the cost of higher expenses and longer operative duration. Methods A retrospective cohort study was done at Shree Birendra Hospital from January 2018 to December 2021, with a total study population of 450 participants (300 in open appendectomy and 150 in laparoscopic appendectomy). Preoperative. Intraoperative and postoperative parameters were compared and analyzed between two groups using SPSS-25. Results The mean age was 26.72 ± 9.70 in the open appendectomy (OA) and years 23.89 ± 6.32 in the laparoscopic appendectomy (LA) group. (p = 0.010) There was a significant difference between the mean operative time (46.08 ± 13.10 min in OA and 56.86 ± 11.70 min in LA, p = 0.000), length of hospital stay (1.28 ± 0.80 days in OA and 1.07 ± 0.25 days in LA, p = 0.000), course of oral analgesics (3.55 ± 0.68 days in OA and 3.00 days in LA p = 0.000) between OA groups and LA groups, while the total number of complications was less in the LA group however there was no statistically significant difference postoperative complications (p = 0.124) between the two groups in the surgical findings. Conclusion All in all, the laparoscopic approach is a better option for uncomplicated appendicitis due to its less postoperative pain and shorter duration of hospital stay.
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Affiliation(s)
- Sunil Basukala
- Department of SurgeryNepalese Army Institute of Health SciencesKathmanduNepal
| | - Niranjan Thapa
- College of Medicine, Nepalese Army Institute of Health SciencesKathmanduNepal
| | - Ujwal Bhusal
- College of Medicine, Nepalese Army Institute of Health SciencesKathmanduNepal
| | - Oshan Shrestha
- College of Medicine, Nepalese Army Institute of Health SciencesKathmanduNepal
| | - Sagun Karki
- College of Medicine, Nepalese Army Institute of Health SciencesKathmanduNepal
| | - Shiva K. Regmi
- College of Medicine, Nepalese Army Institute of Health SciencesKathmanduNepal
| | - Kunda B. Shah
- Department of SurgeryNepalese Army Institute of Health SciencesKathmanduNepal
| | - Aasish Shah
- Department of AnaesthesiaNepalese Army Institute of Health SciencesKathmanduNepal
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Choi YS, Seo JH, Yi JW, Choe YM, Heo YS, Choi SK. Clinical Characteristics of Acute Appendicitis in Pregnancy: 10-Year Experience at a Single Institution in South Korea. J Clin Med 2023; 12:jcm12093277. [PMID: 37176716 PMCID: PMC10179729 DOI: 10.3390/jcm12093277] [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: 04/06/2023] [Revised: 05/01/2023] [Accepted: 05/03/2023] [Indexed: 05/15/2023] Open
Abstract
BACKGROUND Acute appendicitis is the most common cause of non-obstetric surgical disease in pregnant women. The diagnosis and treatment of appendicitis during pregnancy are very important because it can cause life-threatening morbidity to the fetus and mother. We evaluated the clinical characteristics of acute appendicitis in pregnant women. METHODS We retrospectively reviewed a medical database that included patients who underwent surgery for acute appendicitis at our hospital from January 2013 through December 2022. We compared non-pregnant women of reproductive age with pregnant women. We classified the pregnant women according to gestational age. RESULT A total of 828 patients were reproductive-aged women between 15 and 44 years old. There were 759 non-pregnant patients and 69 pregnant patients. ASA (American Society of Anesthesiologists) physical status classes were significantly higher and hospital stays were significantly longer in the pregnant group. There was no significant intergroup difference in terms of the proportions of complicated appendicitis, extended surgery, or complications. When the enrolled pregnant women were divided into three subgroups according to gestational age, the mean operation time was longest in the third-trimester subgroup. There were no differences among the subgroups in terms of the proportions of complicated appendicitis, extended surgery, or complications, nor were there differences among the subgroups in terms of laboratory findings. Preterm labor and stillbirth occurred in two pregnant women with complicated appendicitis in the second trimester. CONCLUSION Immediate surgical treatment should be strongly considered in pregnant women with appendicitis. Efforts for more accurate diagnosis are needed for pregnant women with appendicitis.
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Affiliation(s)
- Yun Suk Choi
- Department of Surgery, Inha University Hospital, Inha University College of Medicine, Jung-gu, Inchon 22332, Republic of Korea
| | - Ji Hyun Seo
- Department of Surgery, Inha University Hospital, Inha University College of Medicine, Jung-gu, Inchon 22332, Republic of Korea
| | - Jin Wook Yi
- Department of Surgery, Inha University Hospital, Inha University College of Medicine, Jung-gu, Inchon 22332, Republic of Korea
| | - Yun-Mee Choe
- Department of Surgery, Inha University Hospital, Inha University College of Medicine, Jung-gu, Inchon 22332, Republic of Korea
| | - Yoon Seok Heo
- Department of Surgery, Inha University Hospital, Inha University College of Medicine, Jung-gu, Inchon 22332, Republic of Korea
| | - Sun Keun Choi
- Department of Surgery, Inha University Hospital, Inha University College of Medicine, Jung-gu, Inchon 22332, Republic of Korea
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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.
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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
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Li Y, Luo X, Wu Y, Yan S, Liang Y, Jin X, Sun X, Mei L, Tang C, Liu X, He Y, Yi W, Wei Q, Pan R, Cheng J, Su H. Is higher ambient temperature associated with acute appendicitis hospitalizations? A case-crossover study in Tongling, China. INTERNATIONAL JOURNAL OF BIOMETEOROLOGY 2022; 66:2083-2090. [PMID: 35913519 DOI: 10.1007/s00484-022-02342-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 04/12/2022] [Accepted: 07/25/2022] [Indexed: 06/15/2023]
Abstract
Existing studies suggested that ambient temperature may affect the attack of acute appendicitis. However, the identification of the quantitative effect and vulnerable populations are still unknown. The purposes of this study were to quantify the impact of daily mean temperature on the hospitalization of acute appendicitis and clarify vulnerable groups, further guide targeted prevention of acute appendicitis in Tongling. Daily data of cases and meteorological factors were collected in Tongling, China, during 2015-2019. Time stratified case-crossover design and conditional logistic regression model were used to evaluate the odds ratio (OR) of ambient temperature on hospitalizations for acute appendicitis. Stratified analyses were performed by sex, age, and marital status. The odds ratio (OR) of hospitalizations for acute appendicitis increased by 1.6% for per 1 ℃ rise in mean temperature at lag3[OR = 1.016, 95% confidence interval (CI): 1.004-1.028]. In addition, our results suggest it is in the women that increased ambient temperature is more likely to contribute to acute appendicitis hospitalizations; we also found that the married are more susceptible to acute appendicitis hospitalizations due to increased ambient temperature than the unmarried; people in the 21-40 years old are more sensitive to ambient temperature than other age groups. The significant results of the differences between the subgroups indicate that the differences between the groups are all statistically significant. The elevated ambient temperatures increased the risk of hospitalizations for acute appendicitis. The females, married people, and patients aged 21-40 years old were more susceptible to ambient temperature. These findings suggest that more attention should be paid to the impact of high ambient temperature on acute appendicitis in the future.
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Affiliation(s)
- Yuxuan Li
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, Hefei, 230032, Anhui, China
- Anhui Province Key Laboratory of Major Autoimmune Diseases, Hefei, 230032, Anhui, China
| | - Xuelian Luo
- Department of Medicine, Tongling Vocational and Technical College, Tongling, 244000, China
| | - Yudong Wu
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, Hefei, 230032, Anhui, China
- Anhui Province Key Laboratory of Major Autoimmune Diseases, Hefei, 230032, Anhui, China
| | - Shuangshuang Yan
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, Hefei, 230032, Anhui, China
- Anhui Province Key Laboratory of Major Autoimmune Diseases, Hefei, 230032, Anhui, China
| | - Yunfeng Liang
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, Hefei, 230032, Anhui, China
- Anhui Province Key Laboratory of Major Autoimmune Diseases, Hefei, 230032, Anhui, China
| | - Xiaoyu Jin
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, Hefei, 230032, Anhui, China
- Anhui Province Key Laboratory of Major Autoimmune Diseases, Hefei, 230032, Anhui, China
| | - Xiaoni Sun
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, Hefei, 230032, Anhui, China
- Anhui Province Key Laboratory of Major Autoimmune Diseases, Hefei, 230032, Anhui, China
| | - Lu Mei
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, Hefei, 230032, Anhui, China
- Anhui Province Key Laboratory of Major Autoimmune Diseases, Hefei, 230032, Anhui, China
| | - Chao Tang
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, Hefei, 230032, Anhui, China
- Anhui Province Key Laboratory of Major Autoimmune Diseases, Hefei, 230032, Anhui, China
| | - Xiangguo Liu
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, Hefei, 230032, Anhui, China
- Anhui Province Key Laboratory of Major Autoimmune Diseases, Hefei, 230032, Anhui, China
| | - Yangyang He
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, Hefei, 230032, Anhui, China
- Anhui Province Key Laboratory of Major Autoimmune Diseases, Hefei, 230032, Anhui, China
| | - Weizhuo Yi
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, Hefei, 230032, Anhui, China
- Anhui Province Key Laboratory of Major Autoimmune Diseases, Hefei, 230032, Anhui, China
| | - Qiannan Wei
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, Hefei, 230032, Anhui, China
- Anhui Province Key Laboratory of Major Autoimmune Diseases, Hefei, 230032, Anhui, China
| | - Rubing Pan
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, Hefei, 230032, Anhui, China
- Anhui Province Key Laboratory of Major Autoimmune Diseases, Hefei, 230032, Anhui, China
| | - Jian Cheng
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, Hefei, 230032, Anhui, China
- Anhui Province Key Laboratory of Major Autoimmune Diseases, Hefei, 230032, Anhui, China
| | - Hong Su
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, Hefei, 230032, Anhui, China.
- Anhui Province Key Laboratory of Major Autoimmune Diseases, Hefei, 230032, Anhui, China.
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Naeem MT, Jamil MA, Anwar MI, Raza H, Asad A, Jamil H, Tahir MJ, Bai J, Ejaz Chauhan TM, Asghar MS. Diagnostic accuracy of Alvarado scoring system relative to histopathological diagnosis for acute appendicitis: A retrospective cohort study. Ann Med Surg (Lond) 2022; 81:104561. [PMID: 36147117 PMCID: PMC9486849 DOI: 10.1016/j.amsu.2022.104561] [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: 06/12/2022] [Revised: 08/28/2022] [Accepted: 08/28/2022] [Indexed: 01/09/2023] Open
Abstract
Background Acute appendicitis (AA) is a surgical emergency that requires prompt diagnosis and suitable management. It may lead to complications resulting in mortality. To evaluate the diagnostic accuracy of the Alvarado scoring system (ASS) for acute appendicitis concerning histopathological data. Methodology About 120 patients were selected for this study consisting of 96 males and 24 females age between 20 and 60. Alvarado scoring system is calculated for each patient after collecting data about demographics, laboratory findings, and clinical examination. Then, we compared it with histopathological diagnosis taking it as a gold standard. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated. SPSS version 20 was used for analyzing the data. Results About 120 patients were included in our study. The male to female ratio was 3:1. Sensitivity and specificity were 83.3% and 41% respectively. While PPV and NPV were 85% and 41% respectively. The negative appendectomy rate was 21%. The area under the curve for receiving operating characteristics is 0.628. Conclusion ASS is a useful diagnostic tool regarding sensitivity and positive predictive value, especially in developing countries. It is cheap, reliable, and can be easily applied. We evaluated the diagnostic accuracy of the Alvarado scoring system (ASS) for acute appendicitis. Sensitivity and specificity were 83.3% and 41%. While PPV and NPV were 85% and 41% respectively.
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Zewdu D, Wondwosen M, Tantu T, Tilahun T, Teshome T, Hamu A. Predictors and management outcomes of perforated appendicitis in sub-Saharan African countries: A retrospective cohort study. Ann Med Surg (Lond) 2022; 80:104194. [PMID: 36045808 PMCID: PMC9422206 DOI: 10.1016/j.amsu.2022.104194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 07/10/2022] [Accepted: 07/10/2022] [Indexed: 12/04/2022] Open
Abstract
Background Previous studies have found an association between various predictors and perforated appendicitis. However, there is limited evidence of studies determining the severity of acute appendicitis (AA) in resource-limited settings. Thus, this study aimed to identify predictors and outcomes of perforated appendicitis (PA) in sub-Saharan countries. Methods This is a retrospective cohort study of 298 adult patients who underwent surgical intervention for acute appendicitis. Demographic characteristics, clinical parameters, intraoperative findings, length of hospital stay, and postoperative complications were collected. We computed multivariate logistic regression to identify predictors of PA. P-value <0.05 was considered statistically significant. Results Of 298 patients, PA was 142(47.65%). The identified risk factors for PA are referred patients (AOR = 3.932; 95% CI (2.201–7.027), fever >38 °C (AOR = 4.569; 95% CI (2.249–9.282), and duration of symptoms >2 days (AOR = 2.704; 95% CI (1.400–5.222). Perforation was associated with an increased rate of postoperative complications (45.07vs. 6.41%; P < 0.001) and a longer length of hospital stay (3 vs. 5 days; P < 0.001). Conclusions The incidences of PA in our study are consistent with other reports in developing countries. Referred patients, longer duration of symptoms >2 days, and presence of fever >38 °C were the best predictors of PA. The overall total postoperative complications and the length of hospital stays were higher in PA. Based on our findings, we recommend that the identified predictors should be considered during the preoperative diagnosis and subsequent management. The rate of Perforated Appendix is relatively high in sub-Saharan countries. Duration of symptoms, fever and referred patients were the predictors of PA. PA increased the risk of postoperative morbidity and length of hospital stays.
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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.
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Choi YS, Yi JW, Chung CTY, Shin WY, Choi SK, Heo YS. Clinical Experience of Emergency Appendectomy under the COVID-19 Pandemic in a Single Institution in South Korea. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:medicina58060783. [PMID: 35744046 PMCID: PMC9230818 DOI: 10.3390/medicina58060783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 06/06/2022] [Accepted: 06/08/2022] [Indexed: 11/16/2022]
Abstract
Background and Objectives: The COVID-19 pandemic has brought serious changes in healthcare systems worldwide, some of which have affected patients who need emergency surgery. Acute appendicitis is the most common surgical disease requiring emergency surgery. This study was performed to determine how the COVID-19 pandemic has changed the treatment of patients with acute appendicitis in South Korea. Materials and Methods: We retrospectively reviewed a medical database that included patients who underwent surgery for acute appendicitis in our hospital from January 2019 to May 2021. We classified the patients into two groups according to whether they were treated before or after the COVID pandemic and 10 March 2020 was used as the cutoff date, which is when the World Health Organization declared the COVID pandemic. Results: A total of 444 patients were included in the “Pre-COVID-19” group and 393 patients were included in the “COVID-19” group. In the “COVID-19” group, the proportion of patients with severe morbidity was significantly lower. The time that the patients spent in the emergency room before surgery was significantly longer in the ”COVID-19” group (519.11 ± 486.57 min vs. 705.27 ± 512.59 min; p-value < 0.001). There was no difference observed in the severity of appendicitis or in the extent of surgery between the two groups. Conclusions: During the COVID-19 pandemic, a statistically significant time delay (186.16 min) was needed to confirm COVID-19 infection status. However, there was no clinical difference in the severity of appendicitis or in the extent of surgery. To ensure the safety of patients and medical staff, a COVID-19 PCR test should be performed.
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Moeng MS, Luvhengo TE. Analysis of Surgical Mortalities Using the Fishbone Model for Quality Improvement in Surgical Disciplines. World J Surg 2022; 46:1006-1014. [PMID: 35119512 DOI: 10.1007/s00268-021-06414-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/20/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND The healthcare industry is complex and prone to the occurrence of preventable patient safety incidents. Most serious patient safety events in surgery are preventable. AIM This study was conducted to determine the rate of occurrence of preventable mortalities and to use the fishbone model to establish the main contributing factors. METHODS We reviewed the records of patients who died following admission to the surgical wards. Data regarding their demography, diagnosis, acuity, comorbidities, categorization of death and contributing factors were extracted from the Research Electronic Data Capture (REDCap) database. Factors which contributed to preventable and potentially preventable mortalities were collated. The fishbone model was used for root cause analysis. The study received prior ethical clearance (M190122). RESULTS Records of 859 mortalities were found, of which 65.7% (564/859) were males. The median age of the patients who died was 49 years (IQR: 33-64 years). The median length of hospital stay before death was three days (IQR: 1-11 days). Twenty-four percent (24.1%) of the deaths were from gastrointestinal (GIT) emergencies, 18.4% followed head injury and 17.0% from GIT cancers. Overall, 5.4% of the mortalities were preventable, and 41.1% were considered potentially preventable. The error of judgment and training issues accounted for 46% of mortalities. CONCLUSION Most surgical mortalities involve males, and around 46% are either potentially preventable or preventable. The majority of the mortality were associated with GIT emergencies, head injury and advanced malignancies of the GIT. The leading contributing factors to preventable and potentially preventable mortalities were the error of judgment, inadequate training and shortage of resources.
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Affiliation(s)
- M S Moeng
- Charlotte Maxeke Johannesburg Academic Hospital (CMJAH), University of the Witwatersrand, Box 7053, Cresta, Johannesburg, Republic of South Africa.
| | - T E Luvhengo
- Clinical Head Department of Surgery, CMJAH, University of the Witwatersrand, Johannesburg, Republic of South Africa
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Symeonidis NG, Pavlidis ET, Psarras KK, Stavrati K, Nikolaidou C, Marneri A, Geropoulos G, Meitanidou M, Andreou E, Pavlidis TE. Preoperative Hyponatremia Indicates Complicated Acute Appendicitis. Surg Res Pract 2022; 2022:1836754. [PMID: 35402695 PMCID: PMC8989617 DOI: 10.1155/2022/1836754] [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] [Received: 02/20/2022] [Revised: 03/20/2022] [Accepted: 03/22/2022] [Indexed: 02/05/2023] Open
Abstract
INTRODUCTION Acute appendicitis is the most common surgical emergency. Early detection of patients with complicated appendicitis leads to prompt surgical management and better outcome. This study investigated the relationship between the severity of acute appendicitis and the presence of preoperative hyponatremia. MATERIALS AND METHODS We retrospectively reviewed the medical files of adult patients operated on for acute appendicitis over a 6-year period. Hyponatremia was defined as serum sodium level of ≤135 mEq/L. Patients were classified into complicated appendicitis and noncomplicated appendicitis according to operative findings and/or histopathology reports. RESULTS A total of 129 patients were identified and included in this study. Complicated appendicitis was found more frequently in female patients and older patients. Hyponatremia was found significantly more frequently in patients with complicated appendicitis (p < 0.001) and also in patients with perforation than without perforation (p=0.047). CONCLUSIONS The present study demonstrated that preoperative hyponatremia is associated with complicated appendicitis. Serum sodium levels, a routine, low-cost laboratory test, could act as an accessory marker aiding surgeons in earlier identification of gangrenous or perforated acute appendicitis.
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Affiliation(s)
- Nikolaos G. Symeonidis
- School of Medicine, Second Surgical Propedeutic Department, Ippokrateio General Hospital, Aristotle University of Thessaloniki, Konstantinoupoleos 49, Thessaloniki 546 42, Greece
| | - Efstathios T. Pavlidis
- School of Medicine, Second Surgical Propedeutic Department, Ippokrateio General Hospital, Aristotle University of Thessaloniki, Konstantinoupoleos 49, Thessaloniki 546 42, Greece
| | - Kyriakos K. Psarras
- School of Medicine, Second Surgical Propedeutic Department, Ippokrateio General Hospital, Aristotle University of Thessaloniki, Konstantinoupoleos 49, Thessaloniki 546 42, Greece
| | - Kalliopi Stavrati
- School of Medicine, Second Surgical Propedeutic Department, Ippokrateio General Hospital, Aristotle University of Thessaloniki, Konstantinoupoleos 49, Thessaloniki 546 42, Greece
| | - Christina Nikolaidou
- School of Medicine, Second Surgical Propedeutic Department, Ippokrateio General Hospital, Aristotle University of Thessaloniki, Konstantinoupoleos 49, Thessaloniki 546 42, Greece
| | - Alexandra Marneri
- School of Medicine, Second Surgical Propedeutic Department, Ippokrateio General Hospital, Aristotle University of Thessaloniki, Konstantinoupoleos 49, Thessaloniki 546 42, Greece
| | - Georgios Geropoulos
- School of Medicine, Second Surgical Propedeutic Department, Ippokrateio General Hospital, Aristotle University of Thessaloniki, Konstantinoupoleos 49, Thessaloniki 546 42, Greece
| | - Maria Meitanidou
- School of Medicine, Second Surgical Propedeutic Department, Ippokrateio General Hospital, Aristotle University of Thessaloniki, Konstantinoupoleos 49, Thessaloniki 546 42, Greece
| | - Emili Andreou
- School of Medicine, Second Surgical Propedeutic Department, Ippokrateio General Hospital, Aristotle University of Thessaloniki, Konstantinoupoleos 49, Thessaloniki 546 42, Greece
| | - Theodoros E. Pavlidis
- School of Medicine, Second Surgical Propedeutic Department, Ippokrateio General Hospital, Aristotle University of Thessaloniki, Konstantinoupoleos 49, Thessaloniki 546 42, Greece
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Abramov R, Neymark M, Harbi A, Gilshtein H. Laparoscopic Appendectomy in the Days of COVID-19. Surg Laparosc Endosc Percutan Tech 2021; 31:599-602. [PMID: 34049368 DOI: 10.1097/sle.0000000000000952] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Accepted: 04/12/2021] [Indexed: 01/03/2023]
Abstract
BACKGROUND Acute appendicitis is one of the most common emergencies treated by general surgeons. The treatment of choice in the majority of cases is laparoscopic appendectomy. In the era of the COVID-19 pandemic, there is a concern for a delayed referral of patients and thus a more advanced presentation of the disease leading to a prolonged and complicated course. METHODS Retrospective review of a computerized database of patients who were admitted with acute appendicitis and underwent laparoscopic appendectomy during the COVID pandemic in a single tertiary center in Israel. Patients were compared with those who were admitted and operated for appendicitis in the same period in the previous year. RESULTS One hundred twenty-three patients underwent laparoscopic appendectomy in the study period in 2020, compared with 109 who had surgery in 2019. During the COVID pandemic 41 patients presented with complicated appendicitis versus 22 patients in 2019 (P=0.0174). The placement of peritoneal drains was more prevalent during the pandemic, 5.5% versus 11.4%, and the use of stapler device for appendicular stump closure (P=0.0105). CONCLUSIONS During the first stage of the COVID-19 pandemic, there was a significant increase in the rate of complicated appendicitis. Patients should be strongly encouraged not to refrain from medical treatment and go to the emergency room with the persistence of symptoms.
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Affiliation(s)
| | | | - Asaf Harbi
- Department of General Surgery
- Colorectal Unit, Rambam Health Care Campus, Haifa, Israel
| | - Hayim Gilshtein
- Department of General Surgery
- Colorectal Unit, Rambam Health Care Campus, Haifa, Israel
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16
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Makaram N, Knight SR, Ibrahim A, Patil P, Wilson MSJ. Closure of the appendiceal stump in laparoscopic appendectomy: A systematic review of the literature. Ann Med Surg (Lond) 2020; 57:228-235. [PMID: 32802324 PMCID: PMC7419254 DOI: 10.1016/j.amsu.2020.07.058] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Accepted: 07/27/2020] [Indexed: 12/15/2022] Open
Abstract
Background Closure of the appendiceal stump is a key step performed during laparoscopic appendicectomy. Inadequate management of the appendiceal stump has the potential to cause significant morbidity. Several methods of stump closure have been described, however high-level evidence is limited. We performed a systematic review evaluating clinical outcomes and quality of the evidence for the methods of appendiceal stump closure. Methods A systematic literature search was performed using Medline, Embase, Cochrane Database and Google Scholar to identify studies comparing appendiceal stump closure methods in laparoscopic appendectomy for acute appendicitis from inception to October 2019. Data regarding operative duration, peri-operative complications, length of stay and costs were collated from all included studies. Results From 160 identified studies, 19 met the inclusion criteria. Endoloops and endoclips provide equivalent clinical outcomes at lower cost, while operative duration was shortest with endoclip closure. Endostapler devices have the lowest rate of peri-operative complications (3.56%), however their cost limits their regular use in many healthcare environments. Post-operative complication rate and length of stay were similar for all stump closure methods. Conclusion: Although there are no significant differences in method of stump closure in laparoscopic appendectomy, closure with endoclips provides the shortest operative duration. There is a need for robust and standardized reporting of cost data when comparing stump closure methods, together with higher level evidence in the form of multi-centre randomized controlled trials before firm conclusions can be drawn regarding the optimal method of stump closure. Currently there is no robust higher order evidence which assesses clinical outcomes, cost and time efficiency of methods of stump closure in laparoscopic appendicectomy. This is the first systematic review to investigate clinical outcomes, cost and quality of current evidence for all methods of laparoscopic appendiceal stump closure in acute appendicitis. No difference was observed in methods of stump closure in complication rate, length of stay, cost, and time efficiency. Endostaplers appear to provide most robust closure, albeit at a higher economic cost. Endoloops appear to provide efficient and successful closure, and are currently the most frequently studied method of closure.
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Affiliation(s)
- N Makaram
- Department of General Surgery, Ninewells Hospital and Medical School, Dundee, DD1 9SY, UK
| | - S R Knight
- Usher Institute, University of Edinburgh, Edinburgh, EH16 4XU, UK
| | - A Ibrahim
- Department of General Surgery, Ninewells Hospital and Medical School, Dundee, DD1 9SY, UK
| | - P Patil
- Department of General Surgery, Ninewells Hospital and Medical School, Dundee, DD1 9SY, UK
| | - M S J Wilson
- Department of General Surgery, Forth Valley Royal Hospital, Larbert, FK5 4WR, UK
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Vedamanickam PR. Appendicular abscess masquerading as right testicular mass. BMJ Case Rep 2019; 12:12/5/e229038. [PMID: 31133552 DOI: 10.1136/bcr-2018-229038] [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: 11/03/2022] Open
Abstract
A 38-year-old man presented with an acute onset of pain and swelling of the right testis. On examination, he was tender in the right iliac fossa (RIF) with a grossly enlarged and tender right testis. Ultrasonography and contrast-enhanced CT of the abdomen and pelvis revealed right epididymo-orchitis, a bulky and inflamed right spermatic cord and a well- defined, thick-walled collection in the RIF.
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Abstract
Objective: To determine the seasonal variation of acute appendicitis. Methods: A total of 320 patients fulfilling the inclusion criteria were enrolled in the study after getting the written informed consent. Appendectomies were performed by consultant surgeons and residents. After surgery histopathological examination of specimens was performed by consultant Histopathologists at Armed Forces Institute of Pathology Rawalpindi and CMH Peshawar. The patients presenting in different four seasons September to November as autumn, December to February as winter, March to May as spring, June to August as summer, were compared to determine seasonal variations. Results: In our study out of all 320 patients 188 (58.75%) were males and 132 (41.25%) were females. Sixty patients (18.75 %) presented in autumn season (Sep-Nov), 52 patients (16.25%) in winter season (Dec-Feb), 78 (24.25%) patients in Spring season (Mar-May).130 (40.62%) patients presented in Summer season (Jun-Aug). There was almost 24.37% increased incidence in summer as compared to winter season, 21.87% increased incidence as compared to autumn season, 16.37% increased incidence as compared to spring season. Conclusion: Acute appendicitis incidence is increased in summer months in Pakistan. Preventive measures can be taken during summer season (June to Aug) to decrease morbidity and mortality associated with this disease.
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Affiliation(s)
- Waqas Ahmed
- Dr. Waqas Ahmed, MBBS, FCPS. Department of Surgery, Combined Military Hospital, Kohat, Pakistan
| | - Muhammad Saeed Akhtar
- Dr. Muhammad Saeed Akhtar, MBBS, MACS, FCPS. Department of Surgery, Combined Military Hospital, Kohat, Pakistan
| | - Shahum Khan
- Dr. Shahum khan, MBBS. Department of Surgery, Combined Military Hospital, Kharian, Pakistan
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Dalpiaz A, Gandhi J, Smith NL, Dagur G, Schwamb R, Weissbart SJ, Khan SA. Mimicry of Appendicitis Symptomatology in Congenital Anomalies and Diseases of the Genitourinary System and Pregnancy. Curr Urol 2017; 9:169-178. [PMID: 28413377 DOI: 10.1159/000447136] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2015] [Accepted: 11/24/2015] [Indexed: 12/29/2022] Open
Abstract
INTRODUCTION Appendicitis is a prevailing cause of acute abdomen, but is often difficult to diagnose due to its wide range of symptoms, anatomical variations, and developmental abnormalities. Urological disorders of the genitourinary tract may be closely related to appendicitis due to the close proximity of the appendix to the genitourinary tract. This review provides a summary of the urological complications and simulations of appendicitis. Both typical and urological symptoms of appendicitis are discussed, as well as recommended diagnostic and treatment methods. METHODS Medline searches were conducted via PubMed in order to incorporate data from the recent and early literature. RESULTS Urological manifestations of appendicitis affect the adrenal glands, kidney, retroperitoneum, ureter, bladder, prostate, scrotum, and penis. Appendicitis in pregnancy is difficult to diagnose due to variations in appendiceal position and trimester-specific symptoms. Ultrasound, CT, and MRI are used in diagnosis of appendicitis and its complications. Treatment of appendicitis may be done via open appendectomy or laparoscopic appendectomy. In some cases, other surgeries are required to treat urological complications, though surgery may be avoided completely in other cases. CONCLUSION Clinical presentation and complications of appendicitis vary among patients, especially when the genitourinary tract is involved. Appendicitis may mimic urological disorders and vice versa. Awareness of differential diagnosis and proper diagnostic techniques is important in preventing delayed diagnosis and possible complications. MRI is recommended for diagnosis of pregnant patients. Ultrasound is preferred in patients exhibiting typical symptoms.
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Affiliation(s)
- Amanda Dalpiaz
- Department of Physiology and Biophysics, Stony Brook University School of Medicine, Stony Brook, N.Y., USA
| | - Jason Gandhi
- Department of Physiology and Biophysics, Stony Brook University School of Medicine, Stony Brook, N.Y., USA
| | | | - Gautam Dagur
- Department of Physiology and Biophysics, Stony Brook University School of Medicine, Stony Brook, N.Y., USA
| | - Richard Schwamb
- Department of Physiology and Biophysics, Stony Brook University School of Medicine, Stony Brook, N.Y., USA
| | - Steven J Weissbart
- Department of Urology, Stony Brook University School of Medicine, Stony Brook, N.Y., USA.,Women's Pelvic Health & Continence Center, Stony Brook University School of Medicine, Stony Brook, N.Y., USA
| | - Sardar Ali Khan
- Department of Physiology and Biophysics, Stony Brook University School of Medicine, Stony Brook, N.Y., USA.,Department of Urology, Stony Brook University School of Medicine, Stony Brook, N.Y., USA
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Malik MU, Connelly TM, Awan F, Pretorius F, Fiuza-Castineira C, El Faedy O, Balfe P. The RIPASA score is sensitive and specific for the diagnosis of acute appendicitis in a western population. Int J Colorectal Dis 2017; 32:491-497. [PMID: 27981378 DOI: 10.1007/s00384-016-2713-4] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/18/2016] [Indexed: 02/04/2023]
Abstract
AIM The definitive diagnosis of acute appendicitis (AA) requires histopathological examination. Various clinical diagnostic scoring systems attempt to reduce negative appendectomy rates. The most commonly used in Western Europe and the USA is the Alvarado score. The Raja Isteri Pengiran Anak Saleha appendicitis (RIPASA) score achieves better sensitivity and specificity in Asian and Middle Eastern populations. We aimed to determine the diagnostic accuracy of the RIPASA score in Irish patients with AA. METHODS All patients who presented to our institution with right iliac fossa pain and clinically suspected AA between January 1 and December 31, 2015, were indentified from our hospital inpatient enquiry database and retrospectively studied. Operating theatre records and histology reports confirmed those who underwent a non-elective operative procedure and the presence or absence of AA. SPSS version 22 was used for statistical analysis. Standard deviation is provided where appropriate. RESULTS Two hundred eight patients were included in the study (106/51% male, mean age 22.7 ± 9.2 years). One hundred thirty-five (64.9%) had histologically confirmed AA (mean symptom duration = 36.19 ± 15.90 h). At a score ≥7.5, the previously determined score most likely associated with AA in Eastern populations, the RIPASA scoring system demonstrated a sensitivity of 85.39%, specificity of 69.86%, positive predictive value of 84.06%, negative predictive value of 72.86% and diagnostic accuracy of 80% in our cohort. CONCLUSION The RIPASA score is a useful tool to aid in the diagnosis of acute appendicitis in the Irish population. A score of ≥7.5 provides sensitivity and specificity exceeding that previously documented for the Alvarado score in Western populations. WHAT DOES THIS PAPER ADD TO THE LITERATURE?: This is the first study evaluating the utility of the RIPASA score in predicting acute appendicitis in a Western population. At a value of 7.5, a cut-off score suggestive of appendicitis in the Eastern population, RIPASA demonstrated a high-sensitivity, specificity, positive predictive value and diagnostic accuracy in our cohort and was more accurate than the commonly used Alvarado score.
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Affiliation(s)
| | - Tara M Connelly
- Department of Surgery, University Hospital Waterford, Waterford, Ireland.
| | - Faisal Awan
- Department of Surgery, St. Luke's Hospital, Kilkenny, Ireland
| | | | | | - Osama El Faedy
- Department of Surgery, St. Luke's Hospital, Kilkenny, Ireland
| | - Paul Balfe
- Department of Surgery, St. Luke's Hospital, Kilkenny, Ireland
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Alvarez-Alvarez F, Maciel-Gutierrez V, Rocha-Muñoz A, Lujan J, Ploneda-Valencia C. Diagnostic value of serum fibrinogen as a predictive factor for complicated appendicitis (perforated). A cross-sectional study. Int J Surg 2016; 25:109-13. [PMID: 26644291 DOI: 10.1016/j.ijsu.2015.11.046] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2015] [Revised: 11/09/2015] [Accepted: 11/22/2015] [Indexed: 12/26/2022]
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22
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Microscopic studies on postmortem vermiform appendix of the adult males of Bangladesh. Ir J Med Sci 2015; 185:249-57. [DOI: 10.1007/s11845-015-1287-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2014] [Accepted: 03/29/2015] [Indexed: 10/23/2022]
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Dinc B, Oskay A, Dinc SE, Bas B, Tekin S. New parameter in diagnosis of acute appendicitis: Platelet distribution width. World J Gastroenterol 2015; 21:1821-1826. [PMID: 25684947 PMCID: PMC4323458 DOI: 10.3748/wjg.v21.i6.1821] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2014] [Revised: 08/24/2014] [Accepted: 10/15/2014] [Indexed: 02/06/2023] Open
Abstract
AIM: To investigate the diagnostic accuracy of the mean platelet volume and platelet distribution width in acute appendicitis.
METHODS: This retrospective, case-controlled study compared 295 patients with acute appendicitis (Group I), 100 patients with other intra-abdominal infections (Group II), and 100 healthy individuals (Group III) between January 2012 and January 2013. The age, gender, and white blood cell count, neutrophil percentage, mean platelet volume, and platelet distribution width values from blood samples were compared among the groups. Statistical analyses were performed using SPSS for Windows 21.0 software. In addition, the sensitivity, specificity, positive and negative predictive values and likelihood ratios, and diagnostic accuracy were calculated.
RESULTS: The mean ages of patients were 29.9 ± 12.0 years for Group I, 31.5 ± 14.0 years for Group II, and 30.4 ± 13.0 years for Group III. Demographic features such as age and gender were not significantly different among the groups. White blood cell count, neutrophil percentage and platelet distribution width were significantly higher in Group I compared to groups II and III (P < 0.05). Diagnostically, the sensitivity, specificity and diagnostic accuracy were 73.1%, 94.0%, and 78% for white blood cell count, 70.0%, 96.0%, and 76.0% for neutrophil percentage, 29.5%, 49.0%, and 34.0% for mean platelet volume, and 97.1%, 93.0%, and 96.0% for platelet distribution width, respectively. The highest diagnostic accuracy detected was for platelet distribution width between Group I and Group III (P < 0.01).
CONCLUSION: Platelet distribution width analysis can be used for diagnosis of acute appendicitis without requiring additional tests, thus reducing the cost and loss of time.
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