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Abstract
PurposeAcute appendicitis may present as uncomplicated and complicated and these disease forms differ both epidemiologically and clinically. Complicated acute appendicitis has traditionally been defined as an appendicitis complicated by perforation or a periappendicular abscess, and an appendicolith represents a predisposing factor of complicated disease. There are histopathological differences between uncomplicated acute appendicitis and the previously established traditional forms of complicated acute appendicitis, but to our knowledge, the histopathological differences between uncomplicated acute appendicitis and complicated acute appendicitis presenting with an appendicolith have not yet been reported. The study purpose was to assess these differences with two prospective patient cohorts: (1) computed tomography (CT) confirmed uncomplicated acute appendicitis patients enrolled in the surgical treatment arm of the randomized APPAC trial comparing appendectomy with antibiotics for the treatment of uncomplicated acute appendicitis and (2) patients with CT-verified acute appendicitis presenting with an appendicolith excluded from the APPAC trial.MethodsThe following histopathological parameters were assessed: appendiceal diameter, depth of inflammation, micro-abscesses, density of eosinophils, and neutrophils in appendiceal wall and surface epithelium degeneration.ResultsUsing multivariable logistic regression models adjusted for age, gender, and symptom duration, statistically significant differences were detected in the depth of inflammation ≤ 2.8 mm (adjusted OR 2.18 (95%CI: 1.29–3.71, p = 0.004), micro-abscesses (adjusted OR 2.16 (95%CI: 1.22–3.83, p = 0.008), the number of eosinophils and neutrophils ≥ 150/mm2 (adjusted OR 0.97 (95%CI: 0.95–0.99, p = 0.013), adjusted OR 3.04 (95%CI: 1.82–5.09, p < 0.001, respectively).ConclusionsThese results corroborate the known clinical association of an appendicolith to complicated acute appendicitis.
Highlights
Acute appendicitis is one of the most common causes of abdominal pain in emergency departments
The aim of our study was to assess these histopathological differences by using a prospective cohort including patients with either computed tomography (CT)-confirmed uncomplicated acute appendicitis enrolled in the surgical treatment arm of the randomized APPAC trial or patients with CT-verified complicated acute appendicitis presenting with an appendicolith excluded from the APPAC trial
This current trial includes patients with either computed tomography (CT)confirmed uncomplicated acute appendicitis enrolled in the surgical treatment arm of the randomized APPAC trial or patients with CT-verified complicated acute appendicitis presenting with an appendicolith excluded from the APPAC trial
Summary
Acute appendicitis is one of the most common causes of abdominal pain in emergency departments. Acute uncomplicated and complicated appendicitis are epidemiologically and clinically different disease entities [1] supporting the idea of a different pathophysiology and disease course. Evidence from recent randomized trials [3,4,5,6,7] and metaanalyses [8,9,10] have shown that patients with uncomplicated acute appendicitis can be treated safely and efficiently with antibiotics. Our recent 5-year results further support the notion that antibiotic treatment alone is a safe alternative to appendectomy for uncomplicated acute appendicitis at long-term follow-up [11]. Antibiotic therapy for uncomplicated acute appendicitis is associated with significant cost savings [12] potentially having a major impact on overall health care costs based on the prevalence of acute appendicitis
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