Indication of conservative treatment by antibiotics for uncomplicated and complicated acute appendicitis.

Background: Identification of complicated and uncomplicated acute appendicitis is important in children. In acute appendicitis, along with clinical evaluation and staging, many laboratory tests have been used. The aim of the study was to compare total leucocyte count in children with uncomplicated and complicated acute appendicitis in different age groups.Methods: Retrospective cohort study was performed in children who underwent appendicectomy, in a Government tertiary care institution between January 2017 and December 2018. 206 patients were divided into complicated and uncomplicated appendicitis. Total leucocyte count at time of admission was compared according to age. Unpaired t test and Chi-square test were used for statistical analysis.Results: There were 136 males and 70 females. 107 patients (51.94%) had complicated and 99 (48.06%) had uncomplicated appendicitis. Mean leucocyte count per µl in uncomplicated appendicitis was 18993±3540 in <5 years, 17155±3386 in 5-10 years and 15833±3613 in 10-15 years. The mean leucocyte count for complicated appendicitis was 19974±3658 in <5 years, 17727±4487 in 5-10 years and 17220±3411 in 10-15 years age group. In 10-15 years group, patients with complicated acute appendicitis had statistically significant higher values of mean total leucocyte count.Conclusions: Total leucocyte count can be used as marker of severity of acute appendicitis in children older than 10 years. In children with clinical suspicion of acute appendicitis, total leucocyte count >20000 per µl signifies complicated appendicitis in all age groups.

Appendectomy has historically been the standard treatment of acute appendicitis, but lately, conservative treatment of uncomplicated acute appendicitis with antibiotics has successfully been used in selected patients. Complicated acute appendicitis is often treated conservatively initially, but may benefit from interval appendectomy due to the higher risk of appendiceal malignancy and recurrence. Recommendations for follow-up after conservatively treated appendicitis vary. Furthermore, the risk of underlying malignancy and the necessity of routine interval appendectomy are unclear. This study aims to evaluate follow-up status, recurrence, and underlying appendiceal malignancy in conservatively treated uncomplicated and complicated acute appendicitis. This study included patients with conservatively treated acute appendicitis at Skåne University Hospital, Sweden during 2012-2019. Information on patient demographics at index admission and data on follow-up, recurrence, number of appendectomies after initial conservative treatment, and underlying malignancy were retrieved from medical charts. The study cohort included 391 patients, 152 with uncomplicated and 239 with complicated acute appendicitis. Median time of study follow-up was 52 months. The recurrence risk was 23 (15.1%) after uncomplicated and 58 (24.3%) after complicated acute appendicitis (p = 0.030). During follow-up, 55 (23%) patients with complicated acute appendicitis underwent appendectomy. Appendiceal malignancies were found in 12 (5%) patients with previous complicated acute appendicitis versus no appendiceal malignancies after uncomplicated acute appendicitis (p = 0.002). The risk of appendiceal malignancy and recurrent appendicitis was significantly higher in patients with complicated acute appendicitis compared with uncomplicated acute appendicitis.

Objectives: Acute appendicitis is the most common non-obstetric pathology requiring emergency surgery on pregnant women. The aim of the study is to show the effect of uncomplicated and complicated acute appendicitis on pregnancy. Methods: This study was conducted retrospectively at the Department of General Surgery of Konya City Hospital. Pregnant patients who underwent surgery for acute appendicitis from January 1, 2020, through December 31, 2021, were included in the study. The cases were divided into two groups as complicated and uncomplicated appendicitis and compared. The demographic, clinical, and laboratory findings of the patients were obtained by screening the patient files. The cases were divided into two groups as complicated and uncomplicated appendicitis and compared. Results: The study included 46 pregnant patients with a mean age of 25.9 years. The mean gestational age of the patients at the time of surgery was 16.5 weeks. Of the patients, 47.8% were in the first trimester. Open appendectomy was performed in 35 (76.1%) patients, and laparoscopic appendectomy in eight (17.4%). Seven (15.2%) appendicitis cases were complicated. A negative appendectomy was performed in two (4.3%) patients. Preterm labor was seen at a rate of 28.6% in the complicated appendicitis group and 5.1% in the uncomplicated appendicitis group (p = 0.04), and the mean operative times were 65.8 and 46.1 minutes, respectively (p < 0.001). Conclusions: Both postoperative complications due to surgery and obstetric complications increase in patients with complicated appendicitis; therefore, it is particularly important to closely follow up these cases.

Tu1575 Conservative Treatment and Interval Appendectomy for Acute Appendicitis

This study aimed to investigate the predictive power of serum systemic inflammatory markers including neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR), monocyte-eosinophil ratio (MER), and C-reactive protein (CRP) levels for distinguishing uncomplicated and complicated acute appendicitis in adult patients admitted to the emergency department (ED). This retrospective, cross-sectional, observational, and single-center study enrolled 212 consecutive adult patients with acute appendicitis who were admitted to the ED of our tertiary care university hospital between January 1, 2019 and December 31 2021. Patients were divided into two groups (Group I, uncomplicated acute appendicitis; Group II, complicated appendicitis) according to their surgical findings and histopathological examination. Systemic inflammatory markers measured on admission were compared among patients to identify factors associated with complicated acute appendicitis. A total of 132 patients, 83 male (62.9%) and 49 female (37.1%), were included in the study. The mean age was 34.7±13.40 years. Based on the histopathological examination, the number of patients in Group I was 103 (78.03%) and 29 (21.96%) in Group II. Laboratory findings on admission revealed no significant differences between Groups I and II patients in terms of mean serum NLR, MER, and CRP values (p=0.096, p=0.248, and p=0.297, respectively). However, the mean serum PLR in Group II patients was statistically significantly higher than those in Group I (p=0.032). The mean serum monocyte and monocyte fraction (%) values were significantly lower, and the mean serum neutrophil fraction (%) value was higher in Group II patients compared to those with Group I. Receiving operator characteristic (ROC) analysis identified a serum PLR cutoff value of ≥133.73 for distinguishing uncomplicated and complicated acute appendicitis in adult patients, with 60% sensitivity and 58.4% specificity. In addition, ROC analysis revealed a cutoff monocyte fraction (%) level of ≤6, with 72% sensitivity and 64% specificity, for distinguishing uncomplicated and complicated acute appendicitis in adult patients. Our findings indicate that the mean serum NLR, MER, and CRP values measured on admission to ED in adult patients with acute appendicitis could not predict complicated acute appendicitis. However, mean serum PLR and neutrophil and monocyte counts can be useful in distinguishing complicated cases.

Is preoperative distinction between complicated and uncomplicated acute appendicitis feasible without imaging?

Treatment strategies for acute uncomplicated appendicitis have evolved and now conservative antibacterial treatment is recommended over surgical treatment, especially for paediatric patients. The aim of this study was to evaluate microbiota in paediatric patients with acute uncomplicated and complicated appendicitis, and antibacterial susceptibility of the causative microorganisms. Bacteriological identification was conducted using the VITEK2 analyser. Antibacterial susceptibility tests were performed and the results were evaluated in accordance with the recommendations of the European Committee on Antimicrobial Susceptibility Testing (EUCAST) “Clinical breakpoints and dosing of antibiotics” (Version 7.0, January 2019). Serodiagnosis of Yersinia enterocolitica was performed using indirect haemagglutination. The results revealed differences in microbiota in cases of acute complicated and acute uncomplicated appendicitis. Pseudomonas aeruginosa was identified more frequently in cases of acute complicated appendicitis. Mixed culture was prevalent in cases of both acute complicated and acute uncomplicated appendicitis. Very few positive extended spectrum beta-lactamase (ESBL) Escherichia coli cultures were identified. Most of strains of Pseudomonas aeruginosa were resistant to amoxicillin with clavulanic acid, ertapenem, ampicillin and cefotaxime. Some of E. coli isolates were resistant to ampicillin and to amoxicillin with clavulanic acid.

While patients with acute uncomplicated appendicitis may be treated conservatively, those who suffer from complicated appendicitis require surgery. We describe a logistic regression equation to calculate the likelihood of acute uncomplicated appendicitis and complicated appendicitis in patients presenting to the emergency department with suspected acute appendicitis. A cohort of 895 patients who underwent appendicectomy were analysed retrospectively. Depending on the final histology, patients were divided into three groups; normal appendix, acute uncomplicated appendicitis and complicated appendicitis. Normal appendix was considered the reference category, while acute uncomplicated appendicitis and complicated appendicitis were the nominal categories. Multivariate and univariate regression models were undertaken to detect independent variables with significant odds ratio that can predict acute uncomplicated appendicitis and complicated appendicitis. Subsequently, a logistic regression equation was generated to produce the likelihood acute uncomplicated appendicitis and complicated appendicitis. Pathological diagnosis of normal appendix, acute uncomplicated appendicitis and complicated appendicitis was identified in 188 (21%), 525 (59%) and 182 patients (20%), respectively. The odds ratio from a univariate analysis to predict complicated appendicitis for age, female gender, log2 white cell count, log2 C-reactive protein and log2 bilirubin were 1.02 (95% confidence interval, CI, 1.01, 1.04), 2.37 (95% CI 1.51, 3.70), 9.74 (95% CI 5.41, 17.5), 1.57 (95% CI 1.40, 1.74), 2.08 (95% CI 1.56, 2.76), respectively. For the same variable, similar odds ratios were demonstrated in a multivariate analysis to predict complicated appendicitis and univariate and multivariate analysis to predict acute uncomplicated appendicitis. The likelihood of acute uncomplicated appendicitis and complicated appendicitis can be calculated by using the reported predictive equations integrated into a web application at www.appendistat.com. This will enable clinicians to determine the probability of appendicitis and the need for urgent surgery in case of complicated appendicitis.

The aim of this study was to assay the variation of procalcitonin (PCT) in adult patients with uncomplicated and complicated acute appendicitis. In total, 336 patients who underwent appendectomy from January 2016 to December 2017 were enrolled. Levels of inflammatory markers, the highest body temperature within the first 24h of admission (BTm) and the duration of operation were recorded. All appendectomy specimens were sent for histopathological examination. According to the histopathological results, 336 patients who underwent appendectomy were divided into uncomplicated acute appendicitis (UAA) group (246 cases) and complicated acute appendicitis (CAA) group (90 cases) for further analysis. The relationships of procalcitonin (PCT) and related indicators with UAA and CAA were evaluated by receiver operating characteristic (ROC) and binary logistic regression analysis. Age, the levels of PCT, and CRP were significantly higher in CAA group (P < 0.05). Spearman correlation analysis showed that PCT was positively correlated with age (r = 0.452, P < 0.01) and CRP (r = 0.715, P < 0.01). The area under the curve (AUC) of PCT, CRP and age were 0.987, 0.902, and 0.748, respectively. ROC analysis showed when PCT > 0.42ng/ml, it maximized the sensitivity and specificity. Logistic regression analysis indicated that PCT remained an independent risk factor for diagnosing CAA after adjusting with age and CRP (P < 0.05). Serum PCT levels increased significantly in patients with CAA. PCT could provide convenient evaluation method for the optimal treatment of acute appendicitis.

Acute appendicitis is inflammation of the vermiformis appendix due to lumen obstruction followed by bacterial infection. Acute appendicitis is classified into two types of disease, namely complicated and uncomplicated. Acute inflammation of the appendix requires immediate surgical action to prevent complications; therefore, a further laboratory test is required. This study was retrospective research which analyzed several hematologic parameters (WBC, Neutrophils, NLR, RDW, PLTMPV, PDW) and serum bilirubin levels. Data were statistically analyzed using Independent-t and Mann-Whitney test. Univariate logistic regression test was used to evaluate the correlation of hematologic parameters and significant serum bilirubin levels with the diagnosis of complicated and uncomplicated appendicitis. The cut-off value and diagnosis value were measured using Receiver Operating Characteristic (ROC) curve analysis. This study involved 173 subjects categorized into 67 complicated and 106 uncomplicated acute appendicitis patients. Whole blood count and neutrophil counts were significantly higher in complicated acute appendicitis (p &lt;0.05). Similarly, NLR and PLT were significantly higher in complicated acute appendicitis (p &lt;0.001), p &gt; 0.05 was obtained in RDW-CV, MPV and PDW values. The higher serum bilirubin levels were reported in patients with complicated acute appendicitis compared to uncomplicated acute appendicitis (p &lt;0.001). Logistic regression test results showed significant PLT parameters with p &lt;0.001, while there was no significance of hematologic parameters such as WBC, neutrophil, NLR, RDW-CV, MPV, PDW and bilirubin levels. Area under curve results on the ROC curve showed 74.4% PLT with sensitivity and specificity of 97.17% and 40.29%, respectively. From the analysis of hematologic parameters and measurement of serum bilirubin levels, only the PLT parameter can be used as one of the parameters for the diagnosis of complicated appendicitis with high sensitivity but low specificity. It was recommended to perform prospective studies with more subjects.

Uncomplicated and complicated acute appendicitis seem to be two different forms of this common abdominal emergency. The contribution of appendiceal microbiota to appendicitis pathogenesis has been suggested, but differences between uncomplicated and complicated appendicitis are largely unknown. We compared the appendiceal microbiota in uncomplicated and complicated acute appendicitis. This prospective single-center clinical cohort study was conducted as part of larger multicenter MAPPAC trial enrolling adult patients with computed tomography or clinically confirmed uncomplicated or complicated acute appendicitis. The microbial composition of the appendiceal lumen was determined using 16S rRNA gene amplicon sequencing. Between April 11, 2017, and March 29, 2019, 118 samples (41 uncomplicated and 77 complicated appendicitis) were available. After adjusting for age, sex, and BMI, alpha diversity in complicated appendicitis was higher (Shannon p = 0.011, Chao1 p = 0.006) compared to uncomplicated appendicitis. Microbial compositions were different between uncomplicated and complicated appendicitis (Bray-Curtis distance, P = 0.002). Species poor appendiceal microbiota composition with specific predominant bacteria was present in some patients regardless of appendicitis severity. Uncomplicated and complicated acute appendicitis have different appendiceal microbiome profiles further supporting the disconnection between these two different forms of acute appendicitis. ClinicalTrials.gov NCT03257423.

PurposeAppendicoliths are one of the important causes of acute appendicitis. Currently, there is no consensus on the relationship between appendicoliths and complicated appendicitis, and opinions on the treatment of appendicolith-associated appendicitis vary. This study aims to determine the significance of appendicolith in acute complicated appendicitis and to assess the characteristics of appendicoliths and Computed tomography (CT) features associated with complicated appendicitis.MethodsA retrospective analysis was conducted on patients who underwent surgical treatment for acute appendicitis at the affiliated hospital of Qingdao University from January 2016 to October 2023. Acute appendicitis was classified into two groups with and without appendicolith based on CT findings, intraoperative observations, and postoperative pathology. The clinical data of the two groups were analyzed and compared. Further subgroup analysis was performed within the appendicolith group based on pathological findings, comparing the location, size, and number of appendicoliths, as well as the length, diameter, and CT features of the appendix.ResultsAmong 331 patients with acute appendicitis, 179 had appendicolith, of which 106 were complicated appendicitis and 73 were uncomplicated appendicitis. Among 152 patients without appendicolith, 44 had complicated appendicitis and 108 had uncomplicated appendicitis. appendicoliths were independently associated with complicated appendicitis (OR = 1.88, 95% CI: 1.04–3.40, p = 0.036). In patients with appendicolith appendicitis, three factors were independently associated with complicated appendicitis: appendiceal diameter (OR = 1.20; 95% CI: 1.03–1.40), moderate-severe fat stranding (OR = 17.61; 95% CI: 3.19–97.33), and periappendiceal air (OR = 9.78; 95% CI: 1.17–81.46).ConclusionAppendiceal appendicoliths are closely related to acute complicated appendicitis. The diameter of the appendix and moderate-severe fat stranding, periappendiceal air on CT are significant indicators for identifying complicated appendicitis in acute appendicitis with appendicolith.

To determine whether hydronephrosis is a predictive factor for complicated acute appendicitis in patients with acute appendicitis. Observational, analytical, cross-sectional study; Patients with a histopathological diagnosis of acute appendicitis were included from the Department of Surgery of the Trujillo Regional Teaching Hospital between June and December 2022. They were divided into two groups, complicated and uncomplicated acute appendicitis. Abdominal ultrasound was evaluated to detect the presence or absence of hydronephrosis. Statistical data were analyzed using the Student's t-test for quantitative variables and Chi square for qualitative variables, considering p<0.05 statistically significant. It was found that 95 of 145 patients (65.5%) had complicated acute appendicitis with histopathological diagnosis, and 50 of 145 patients (34.4%) had uncomplicated appendicitis. Of the patients with complicated acute appendicitis, 6.32% (6) had right hydronephrosis, compared with 2% (1) (p=0.249). Operative time was identified as a statistically significant factor (p<0.05) of complicated acute appendicitis, at an average of 71.34±32.20 minutes in complicated acute appendicitis versus 52.16±21.16 in the other group. No association was found between the presence of hydronephrosis and complicated acute appendicitis.

Appendiceal tumors are rare, but high neoplasm rates have been reported at interval appendectomy after periappendicular abscess. Non-operative management of uncomplicated acute appendicitis has shown promising results. The data on appendiceal tumor incidence and presentation among acute appendicitis patients is limited, especially in patient cohorts differentiating between uncomplicated and complicated acute appendicitis. Objective was to assess appendiceal tumor incidence and tumor association to appendicitis in patients with uncomplicated and complicated acute appendicitis. This nationwide population-based registry study was conducted from 2007 to 2013. The Finnish Cancer Registry and the National Institute for Health Registry were used to combine data on all appendiceal tumors and acute appendicitis diagnosis with medical reports evaluated at eight study hospitals. Altogether, 840 appendiceal tumors were identified, and out of these, 504 patient reports were reviewed, including 472 patients in this study. Tumor was diagnosed at appendectomy for suspected acute appendicitis in 276 patients (58%). In the whole study, histologically acute appendicitis and tumor were both present in 53% (n= 250), and out of these, 41% (n= 102) were complicated and 59% (n= 148) uncomplicated acute appendicitis. The associated tumor risk was significantly higher in complicated acute appendicitis compared with uncomplicated cases (3.24% vs. 0.87%, p< 0.001). Overall tumor prevalence among acute appendicitis patients was 1.24%. Appendiceal tumor prevalence in acute appendicitis was low. Tumor risk was significantly higher in complicated acute appendicitis compared with uncomplicated acute appendicitis. The risk of missed appendiceal tumors related to antibiotic therapy of uncomplicated acute appendicitis is very low.

Objective: To define the value of Tamsulosin drug addition to antibiotics (Ceftriaxone and Metronidazole) in conservative treatment of nonperforated acute appendicitis. Patients and methods: Prospective clinical study performed in Al-Jamhoory Teaching Hospital covering a period from Jan 2010 to Jan 2012. Formal consent from the patients and ethical approval were obtained. One-hundred and two patients including 74 males and 28 females, with age range of 17-45 years were admitted to the surgical unit number 3 complaining of acute appendicitis. Detailed clinical history was taken and clinical examination was carried out. All the patients had general urine examination (G.U.E), ultra sound (U.S) of the right iliac fossa and determination of serum c.reactive protein level. Those who had complicated appendicitis were excluded from the study. The patients were randomly divided into two groups A and B. Group A: Fifty one patients were given 500 mg of Ceftriaxone and 500 mg Metronidazole, both I.V twice daily. Group B: Fifty one patients were given the antibiotics regime plus Tamsulosin 0.4 mg orally once daily. The patients who had good signs of response (decrease or disappearance of the abdominal pain, tenderness and rebound tenderness and return of appetite) in the first 24 hours of the treatment continued the treatment for further 5 days, if there was no good response immediate appendicectomy was done. There was follow up of discharged patients for 4 months. Results: Group A: Forty-one patients out of 51 (80.39%) had a good signs of response (decrease or disappearance of the abdominal pain, tenderness and rebound tenderness and return of appetite) within the first 24 hours post presentation while 10 patients needed appendicectomy. Group B: Forty-nine patients (out of 51) 96.07% had good signs of response (decrease or disappearance of the abdominal pain, tenderness and rebound tenderness and return of appetite) within the first 24 hours post presentation and only 2 patients needed appendicectomy. Those who were discharged after conservative treatment were followed up for 4 months. Five patients in group A and 3 patients in group B had recurrence of symptoms and signs of acute appendicitis and appendicectomy was performed for them. Conclusion: Tamsulosin added to antibiotics for treatment of acute appendicitis is safe and resulted in speedy recovery of the patients with reduced recurrence of the condition. .