Diagnostic and therapeutic value of endoscopic retrograde appendicitis therapy for acute appendicitis

Abstract

Objective To study the diagnostic and therapeutic value of endoscopic retrograde appendicitis therapy (ERAT) for acute appendicitis. Methods A total of 21 patients with suspected acute uncomplicated appendicitis underwent emergent ERAT. Findings of acute appendicitis including colonoscopic imaging and endoscopic retrograde appendicography (ERA) imaging were analyzed. Results One of the 21 patients with suspected acute appendicitis was excluded, and 20 patients who were diagnosed as having acute appendicitis underwent ERAT successfully, with success rate of 100%(20/20). No patient was transferred to emergent appendectomy. Mean operative time of ERAT was 49.7±18.2 min and mean hospital stay was 3.3±1.6 d. Diagnosis of acute appendicitis was based on endoscopic imaging and ERA. Endoscopic imaging characteristics included mucosal hyperemia and swelling of appendiceal orifice and nearby area (75%, 15/20), appendicoliths (70%, 14/20) and pus at the appendiceal orifice (25%, 5/20). ERA imaging characteristics included dilation or stenosis of appendiceal lumen (85%, 17/20), intraluminal appendicoliths (70%, 14/20) and extravasation of contrast agent (5%, 1/20). Conclusion ERAT is a valuable procedure for the diagnosis and treatment of acute appendicitis. Such characteristics as endoscopic imaging (mucosal inflammation, appendicoliths and maturation) and ERA (inflammation, intraluminal appendicoliths and perforation) are valuable for diagnosis, while the morphological changes of appendix are the most valuable. Key words: Appendicitis; Endoscopy, digestive system; Diagnosis; Endoscopic retrograde appendicitis therapy