Diagnostic Efficiency of Multidetector Computed Tomography in the Evaluation of Clinically Equivocal Cases of Acute Appendicitis with Surgical Correlation

Diagnosis and treatment of appendicitis: systematic review and meta-analysis

BACKGROUND

The optimal diagnosis and treatment of appendicitis remains controversial. This systematic review details the evidence and current best practices for the evaluation and management of uncomplicated and complicated appendicitis in adults and children.

METHODS

Eight questions regarding the diagnosis and management of appendicitis were formulated. PubMed, Embase, CINAHL, Cochrane and clinicaltrials.gov/NLM were queried for articles published from 2010 to 2022 with key words related to at least one question. Randomized and non-randomized studies were included. Two reviewers screened each publication for eligibility and then extracted data from eligible studies. Random effects meta-analyses were performed on all quantitative data. The quality of randomized and non-randomized studies was assessed using the Cochrane Risk of Bias 2.0 or Newcastle Ottawa Scale, respectively.

RESULTS

2792 studies were screened and 261 were included. Most had a high risk of bias. Computerized tomography scan yielded the highest sensitivity (> 80%) and specificity (> 93%) in the adult population, although high variability existed. In adults with uncomplicated appendicitis, non-operative management resulted in higher odds of readmission (OR 6.10) and need for operation (OR 20.09), but less time to return to work/school (SMD - 1.78). In pediatric patients with uncomplicated appendicitis, non-operative management also resulted in higher odds of need for operation (OR 38.31). In adult patients with complicated appendicitis, there were higher odds of need for operation following antibiotic treatment only (OR 29.00), while pediatric patients had higher odds of abscess formation (OR 2.23). In pediatric patients undergoing appendectomy for complicated appendicitis, higher risk of reoperation at any time point was observed in patients who had drains placed at the time of operation (RR 2.04).

CONCLUSIONS

This review demonstrates the diagnosis and treatment of appendicitis remains nuanced. A personalized approach and appropriate patient selection remain key to treatment success. Further research on controversies in treatment would be useful for optimal management.

Why is the rate of perforated appendicitis higher in girls in eastern Turkey, unlike the literature?

Aim:

Appendicitis is the most common cause of surgical abdominal pain in children. The incidence of appendicitis is higher in boys than girls. Delay in diagnosis may result in perforation of the appendix. Aim of this study is, to examine the terms of gender distribution of perforated appendicitis cases in eastern Turkey.

Material and Methods:

Patients who underwent appendectomy in our clinic between the years of 2017–2018 were classified according to histopathology results as acute appendicitis and perforated appendicitis. Two groups was evaluated in term of; the age, gender, and length of hospital stay.

Results:

Of the patients included in the study, 168 were male and 99 were female. The incidence of perforated appendicitis was higher in girls (%59), (p=0,001) and acute appendicitis was higher in boys (%63), (p=0,001). The mean age was 11.44±3.50 years in acute appendicitis and 9.22±4.26 years in perforated appendicitis. In perforated appendicitis, the mean length of hospital stay (6,73 day) was longer than acute appendicitis (2,59 day) (p=0,001). In addition, the mean length of hospital stay (8,13 day) for girls with perforated appendicitis was statistically significantly longer than boys (6,03 day), (p=0,001).

Conclusion:

While diagnosing appendicitis in the east of Turkey; living environment of the child, education level of the family, socioeconomic status and cultural structure of the society must be considered. It should not be forgotten that the rate of perforated appendicitis in girls is higher than boys in this region.