Acute Appendicitis In Patients Research Articles

Asymptomatic Appendiceal Mucocele with Typical Onion Skin Sign on Ultrasound

Appendiceal mucocele is an obstructive dilatation of the appendix caused by abnormal accumulation of mucoid material. Its incidence is 0.2-0.3% of all appendectomy specimens and it does not have typical clinical features. It can mimic acute appendicitis in patients with right lower quadrant pain. Some patients have appendiceal mucocele with acute appendicitis. For this condition, 25% of cases were asymptomatic and were discovered incidentally on ultrasound examination, computed tomography, or colonoscopy due to nonspecific abdominal symptoms. Ultrasound examination or computed tomography is an important diagnostic tool for accurate preoperative diagnosis. If mucocele is treated incorrectly, pseudomyxoma peritonei may develop. The present study reports a case of a 79-year-old male with constipation. Ultrasonography showed a typical layered echogenic pattern of the appendiceal wall (onion sign or onion skin sign), which suggested appendiceal mucocele. Computed tomography showed a dilated appendix filled with low-attenuated material, indicating a pathologic diagnosis of low-grade appendiceal mucinous neoplasm.

Prevalence of Cardiovascular Dysfunction and its Association with Outcomes in Patients with Acute Pancreatitis

Background and Aim: Acute pancreatitis is a rapid progressive abdominal inflammatory disease with acute onset in clinics which turns into severe acute pancreatitis. In approximately 20% of patients characterized by different parameters such as gland flaky necrosis, multiple organ dysfunction syndrome (MODS), inflammatory cell infiltration in large number, and hemorrhage. Electrocardiography and electromyography variations are the common cardiac failure in patients with acute pancreatitis. Elevated cardiac enzymes could be other factors for cardiac failure with acute pancreatitis. The present study aimed to assess the prevalence of cardiovascular dysfunction and its association in patients with acute pancreatitis. Methodology: This cross-sectional study was carried out on 120 acute appendicitis patients in the department of Gastroenterology at Northwest General Hospital & Research Centre, Hayatabad Peshawar for the duration of six months from June 2021 to November 2021. All the patients who met the inclusion criteria were enrolled. Echocardiography and CK-MB (creatine phosphokinase isoenzyme) was measured for evaluating myocardial function after admission. All the patients underwent physical, clinical, and laboratory examination. The findings of Electrocardiography (ECG) were recorded. Acute appendicitis severity, duration of hospital stay, infection, computed tomography severity index (CTSI), and mortality were different outcomes. Results: Of the total 120 patients, about 83 (69.2%) were males and 37 (30.8%) were females. The overall mean age was 37.84±12.46 years. Out of 120 acute pancreatitis patients, the prevalence of gallstone disease, organic failure, respiratory failure, acute kidney failure, and cardiovascular dysfunction was 51 (43.3%), 47 (39.2%), 37 (30.8%), 19 (15.8%), and 9 (7.5%) respectively. Elevated CK-MB and ECG changes were seen in 32 (26.7%) and 42 (35%) respectively. The ECG variations and elevated CK-MB were related with severity of acute pancreatitis (p<0.05), duration of hospital (OR: 18.9 ± 10.6 vs. 11.7 ± 6.8, p = 0.005), CTSI (6.9 ± 3.1 vs. 4.7 ± 2.9, p = 0.001), increased necrosis (2.34, 95%CI= 0.3-11.8, p=0.011), and mortality (OR= 5.46, 95% CI= 1.2-34.9, p=0.05). The incidence of Left ventricular systolic dysfunction (LVEF) and left ventricular diastolic dysfunction (LVDD) was 15 (12.5%) and 31 (25.8%) respectively. Conclusion: The present study found that elevated CK-MB were significantly associated with higher CTSI, Prolonged hospital stay, severity of acute pancreatitis, LVDD, increased necrosis, and mortality. CK-MB increased levels have been reported as an indicator for cardiac failure and acute pancreatitis. There was a significant association between increased CK-MB levels and cardiovascular organ failure, pancreatic necrosis, and left ventricular diastolic dysfunction. Keywords: Cardiovascular dysfunction, Acute pancreatitis, Outcomes

The association between appendicitis severity and patient age with appendiceal neoplasm histology—a population-based study

PurposeRecent studies have reported alarming appendiceal tumor rates associated with complicated acute appendicitis, especially in patients presenting with a periappendicular abscess. However, the data on histology of appendiceal tumors among acute appendicitis patients is limited, especially in patient cohorts differentiating between uncomplicated and complicated acute appendicitis. We have previously reported the association of increased appendiceal tumor prevalence with complicated acute appendicitis in this population-based study. The objective of this secondary analysis was to evaluate the association of both appendicitis severity and patient age with appendiceal tumor histology.MethodsThis nationwide population-based registry study (The Finnish Cancer Registry) was conducted from 2007 to 2013. All appendiceal tumors (n = 840) and available medical reports (n = 504) of these patients at eight study hospitals were previously evaluated, identifying altogether 250 patients with both acute appendicitis and appendiceal tumor.ResultsThe severity of acute appendicitis was significantly associated with more malignant tumor histology. The risk of adenocarcinoma or pseudomyxoma was significantly higher among patients with periappendicular abscess (OR 15.05, CI 95% 6.98–32.49, p < 0.001) and patients presenting with perforated acute appendicitis (OR 4.09, CI 95% 1.69–9.90, p = 0.0018) compared to patients with uncomplicated acute appendicitis. Similarly, patient age over 40 years was significantly associated with the risk of adenocarcinoma and pseudomyxoma (OR 26.46, Cl 95% 7.95–88.09, p < 0.001). Patient sex was not associated with a more malignant appendiceal tumor histology (p = 0.67).ConclusionMore malignant appendiceal tumor histology of adenocarcinoma or pseudomyxoma was significantly associated with patient age over 40 years and complicated acute appendicitis, especially periappendicular abscess.

Comparative Effectiveness of Endoloop, Instrumental Tie and Ligaclip in Laparoscopy Appendectomy

Background: Appendectomy is the most commonly performed surgical procedure for patients. To examine the safety, complications, and cost-effectiveness of the instrumental tie, ligaclip and endoloop procedures have been used for the closure of the appendix stump. The objective of this study was to analyze the clinical outcomes, as well as to compare the effectiveness of the endoloop, instrumental tie, and ligaclip in laparoscopic appendectomy procedures. Methods: The Sir Syed Medical College Hospital, Karachi was the center of this Randomized Control Study, from June 2020 to December 2020. Acute appendicitis patients (n=120) having age 7-85 years were categorized into three groups: A, B, and C. Ligaclips were applied to those in Group A, Instrumental Tie to Group B, and Endolope to Group C patients. Each group consisted of 40 participants. The Kolmogorov Smirnov test was used to determine the variables for normal distribution. The Chi-square test was used to measure the association between the duration of surgery and hospital stay. Results: The statistical significance (p&lt;0.05) of the relationship between the length of hospital stay and the duration of surgery had been established. The ligaclip demonstrates the shortest hospital stay of 2-3 days and the shortest operation time of 50-60 minutes, whereas the instrumental tie displayed the longest operation time of 72-75 minutes and the longest hospital stay of 4-5 days. Conclusion: Ligaclip application of the appendiceal base showed statistically significant outcomes (p=0.00) regarding technical comfort, cost-effectiveness and operating time compared to endoloop and surgical tie applications. Keywords: Ligaclip; Instrumental Tie; Endoloop; Laparoscopy Appendectomy.

Characterization of peritoneal reactive ascites collected from acute appendicitis and small bowel obstruction patients

BackgroundPathological abdominal adhesions can cause bowel obstructions. A history of appendectomy (appy) increases patient rehospitalization risk directly related to adhesions. To potentially identify strategies for adhesion treatment, we characterized reactive ascites (rA) collected during appy or adhesiolysis for small bowel obstruction (SBO). MethodsThis is a non-randomized, prospective observational study recruiting patients with non-perforated appendicitis or SBO from three Level 1 trauma centers in the United States. rA were analyzed via liquid chromatography-mass spectrometry (LC-MS) (n = 31), bead-based quantification cytokines and chemokines (n = 32) and soluble receptors (n = 30), and LC-MS metabolomics (n = 18). ResultsLC-MS showed that samples contained albumin, apolipoprotein A1, and transthyretin and that metabolites increased in SBO vs appy rA were biomarkers of oxidative stress. Multi-plex analyses showed levels of 17 cytokines/chemokines and 6 soluble receptors were significantly different in appy vs SBO rA. Top increased proteins in appy compared to SBO rA by 20.14-, 11.53-, and 8.18-fold were granulocyte-colony stimulating factor, C-X-C motif chemokine ligand 10, and interleukin-10, respectively. ConclusionsThese data further define pro- and anti-inflammatory mediators and metabolites that may drive formation or perpetuate chronic abdominal adhesions. Future research is to further explore whether attenuation of these factors may decrease pathologic adhesion formation.

GEBELİKTE AKUT APANDİSİT OLGULARINA YAKLAŞIM; BİR DEVLET HASTANESİ PRATİĞİ

Objective&#x0D; Acute appendicitis is the most common non-obstetric&#x0D; surgery performed during pregnancy. Physiological&#x0D; and anatomical changes specific to pregnancy&#x0D; complicate the diagnosis and treatment processes.&#x0D; It has been seen in the literature that the studies on&#x0D; this subject mostly reflect the experiences of tertiary&#x0D; centers. The present study aimed to present the&#x0D; perioperative experience of acute appendicitis cases&#x0D; in pregnancy in a secondary care hospital.&#x0D; Materials and Methods&#x0D; The present study was carried out retrospectively&#x0D; between January 2015 and November 2020 in a&#x0D; secondary state hospital. Patients diagnosed with&#x0D; acute appendicitis during pregnancy and whose&#x0D; postoperative follow-ups and labors were carried out&#x0D; in our hospital were included in the study.&#x0D; Results&#x0D; The median age of the patients was 24 years (18-&#x0D; 35), the median gestational week was 17 weeks (8-&#x0D; 32). The median leukocyte count was 11.6 x103 uL,&#x0D; neutrophil count was 8.6 x103 uL, lymphocyte count&#x0D; was 2 x103 uL, thrombocyte count was 271 x x103 uL,&#x0D; C-reaktif protein was 4.5, neutrophil/ leukocyte ratio&#x0D; was 4.3, thrombocyte/lymphocyte was ratio 120.8,&#x0D; and the leukocyte /C-reaktif protein ratio was 0.7.&#x0D; Spinal anesthesia was the most preferred method and&#x0D; it was observed that open surgery was performed in&#x0D; all patients. The median week of delivery was 38 (36-&#x0D; 40) and preterm labor was seen in only one patient.&#x0D; It was observed that no additional maternal or fetal&#x0D; complications developed.&#x0D; Conclusion&#x0D; Pregnant acute appendicitis patients can also be&#x0D; successfully treated in secondary service hospitals on&#x0D; the condition of a multidisciplinary approach.

Effectiveness of Ultrasound Guided Trans-versus Abdominis Plane (TAP) Block with Landmark Technique Guided TAP Block for Open Appendectomy

Objective: To compare the analgesic efficacy of ultrasound (US) guided TAP block with landmark technique guided TAP block for management of post-op pain after open appendectomy in patients of acute appendicitis. Methods: In this study, we include 80 patients of acute appendicitis who were planned for open appendectomy were included. The study was conducted from June-2021 to Jan-2022 in Nishtar Hospital Multan. In Landmark TAP group; TAP block was given using bupivacaine (0.25%) after completion of surgical procedure using blind landmark technique. In US TAP group; TAP block was administered under US supervision. VAS Score and time of first rescue analgesia were main study outcomes. Results: Mean age was 33.5±9.9 years in landmark TAP group and 32.8±10.4 years in US TAP group (p-value 0.75). There was no significant difference in mean VAS score at 1, 6, 12 and 18 hours after surgery between the groups, However, after 24 hours of surgery mean VAS score was higher in landmark TAP group; 3.5±1.2 versus 2.9±1.0 in TAP group (p-value 0.02). Time of first rescue analgesia was significantly prolonged in US TAP group; 1320.7±275.9 minutes versus 1180.4±320.7 minutes in landmark TAP group (p-value 0.04). Conclusion: Ultrasound guided TAP block is superior to landmark guided TAP block, as it provides better analgesic outcomes in comparison of landmark guided TAP block. Keywords: Ultrasonography, landmark technique, transversus abdominus plane block.

Acute appendicitis in patients with COVID-19

<h3>ЦЕЛЬ ИССЛЕДОВАНИЯ</h3> Анализ результатов диагностики и лечения острого аппендицита (ОА) у пациентов, инфицированных SARS-CoV-2. <h3>МАТЕРИАЛ И МЕТОДЫ</h3> С 16 марта 2020 г. по 31 октября 2021 г. пролечены 139 пациентов с подозрением на ОА на фоне COVID-19, у 104 больных (62 женщины, 42 мужчины) диагноз ОА был подтвержден. Критериями включения являлись: клиническая картина ОА, положительный результат полимеразной цепной реакции (ПЦР) на SARS-CoV-2 или характерная для COVID-19 картина вирусной пневмонии по результатам компьютерной томографии (КТ). Для уточнения диагноза острого аппендицита всем пациентам проводилась КТ органов брюшной полости. <h3>РЕЗУЛЬТАТЫ</h3> При оценке клинической картины ОА на фоне COVID-19 не выявлено специфических признаков. Системный воспалительный ответ мог быть обусловлен как хирургическим заболеванием, так и вирусной инфекцией, что затрудняло интерпретацию изменений. Однако у 88 (84,61%) пациентов в анализе крови выявлен лейкоцитоз от 11,81 до 34,83·10⁹/л, который не характерен для пациентов с COVID-19 в начале заболевания. Среднее время от начала клинических проявлений ОА до проведения операции составило 57±14 ч. Из 139 диагностических лапароскопий диагноз ОА подтвержден в 104 (74,8%) случаях; 102 пациентам выполнена лапароскопическая аппендэктомия с дренированием малого таза, 1 больному — лапаротомия, аппендэктомия, интубация тонкой кишки, 1 пациенту — лапароскопическая резекция дивертикула Меккеля и аппендэктомия. Положительный результат ПЦР на SARS-CoV-2 выпота из брюшной полости подтвердился у 45 (60%) из 75 пациентов. По результатам патоморфологического исследования у 89 (85,58%) пациентов диагностирован флегмонозный аппендицит, у 8 (7,69%) — гангренозный аппендицит, у 7 (6,73%) — гангренозно-перфоративный аппендицит. Летальность составила 0,96% (умер 1 пациент). <h3>ЗАКЛЮЧЕНИЕ</h3> Диагностические проблемы ОА на фоне COVID-19 связаны со сложностями интерпретации как локальных симптомов, так и системного воспалительного ответа. Лапароскопия является ведущим диагностическим методом при подозрении на ОА, в том числе при COVID-19, так как результаты КТ органов брюшной полости у большинства пациентов оказались неинформативны. В отсутствие тяжелого течения пневмонии у большинства больных возможно проведение лапароскопической аппендэктомии. Все операции следует осуществлять в соответствии с противоэпидемическими мероприятиями. Клиническое значение выявления SARS-CoV-2 в брюшной полости нуждается в дальнейшей оценке. Прогноз для пациентов определяется в большей степени течением COVID-19. Тактика лечения больных COVID-19, для которых оперативное вмешательство связано с крайне высоким риском, нуждается в уточнении.

The role of immature granulocyte in the early prediction of acute perforated and nonperforated appendicitis in children.

Acute appendicitis (AA) is the most common reason for pediatric abdominal surgery in the world. Despite ad-vances in science and technology, diagnosing AA is still difficult today, and complications are common as a result. The early prediction of complicated appendicitis is of great importance for the surgical planning, further treatments, and predicting the course of disease. The immature granulocyte (IG) is a new and more effective marker in predicting the severity of inflammation than traditional markers. Our aim is to determine the effectiveness of IG% in the diagnosis and severity of AA. Eighty-eight patients diagnosed with AA and a control group of fifty-eight healthy children were included in this prospec-tive study. Patients with pathologically confirmed AA were divided into two subgroups: acute simple appendicitis (ASA) and acute perforated appendicitis (APA). The demographic characteristics, white blood cell (WBC) count, neutrophil-to-lymphocyte ratio (NLR), mean platelet volume (MPV), IG%, and C-reactive protein (CRP) values were analyzed. Receiver operating characteristics (ROC) anal-ysis was used to compare the diagnostic accuracies and predictive performances. Patients with AA had higher IG%, WBC count, NLR, and MPV value than control group (p=0.28, p=0.22, p<0.001, p=0.001, respectively). Only IG% showed statistically significant difference from other inflammatory markers evaluated in ASA and APA patients (p<0.001). ROC analysis showed that IG% is a good predictor for the presence of APA at an optimal cut-off for IG being 0.2% (sensitivity 81.8%, specificity 85.2%, area under the ROC curve 0.83). In the present study, we demonstrated that AA patients with higher IG levels might be more likely to develop perforation. The IG values combined with a physical examination, imaging studies, and other laboratory tests may help clinicians to identify high-risk AA patients in the pediatric emergency department.

Comparison Of C-Reactive Protein And High-Sensitivity C-Reactive Protein in Acute Appendicitis Patients With Normal White Blood Cells Counts

Objective: Acute appendicitis is one of the main causes of acute abdominal pain. The main goal of treatment is early diagnosis and emergency surgical intervention. Late diagnosis leads to complex acute appendicitis (gangrene, abscess, and perforation). Although the signs and symptoms of acute appendicitis are well known, it is sometimes difficult to diagnose. Various laboratory markers have been studied for the diagnosis of acute appendicitis, but none showed superiority over physical examination or imaging. In addition, the superiority of high-sensitivity C-reactive protein (hs-CRP) over C-reactive protein (CRP) in patients diagnosed with acute appendicitis has not been evaluated in any study to date. With the current study, we aimed to compare CRP and HsCRP values in patients with acute appendicitis whose white blood cells (WBC) are in the normal range. Materials and methods: In this study, serum levels of CRP and hs-CRP were measured in 45 patients with acute appendicitis (who had normal WBC values) and 42 healthy controls. The results obtained were statistically evaluated in terms of significant differences between the two study groups. In addition, ROC (Receiver Operating Characteristic) analysis was performed to determine the power of CRP and HsCRP in the differential diagnosis of acute appendicitis. Results: CRP and HsCRP levels of the patient group were significantly higher than the control group (0,002 and &lt;0,001 respectively). ROC analysis results revealed that HsCRP has higher diagnostic power than CRP in discriminating between AA patients and healthy people. Conclusion: This study showed that HsCRP may be a more effective biochemical marker in the diagnosis of acute appendicitis instead of CRP.

Impact of COVID-19 Pandemic on Paediatric Appendicitis at a Tertiary Care Paediatric Hospital in New DelhiA Retrospective Study

Introduction: Across the globe the healthcare system was severely affected by Coronavirus Disease-19 (COVID-19) pandemic. Measures taken to curtail the spread of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) virus have severely affected the paediatric patients presenting with Acute Appendicitis (AA). Aim: To assess the impact of COVID-19 on paediatric Acute Appendicities patients at tertiary care center in New Delhi. Materials and Methods: A retrospective analysis of patient demographics, symptomatology including delay in presentation to hospital, haematological, intraoperative findings and complications of all paediatric AA patients who underwent appendectomy from 23rd March 2020 to 22nd July 2020 (Pandemic Group- PG group) were performed. Patients presenting in corresponding time period in the year 2019 were also compared {Non Pandemic Group (NPG) group}. Group comparisons for continuously distributed data were made using Independent sample t-test. For non normally distributed data, non parametric tests in the form of Wilcoxon test were used. Chi-squared test was used for group comparisons for categorical data. Results: A total of 72 patients were included with 39 in NPG and 33 in PG group respectively. There were no significant differences between the two groups in terms of age (p-value=0.759) and sex distribution (p-value=0.93). Patients in PG group had higher leukocyte counts as compared to NPG group (16748.48±7744.08 vs 12510.26±7736.58, p-value &lt;0.007). There was no significant difference in delay in presentation, symptomatology, duration of hospital stay and postoperative complications rate between the two groups. Conclusion: There has been no significant change in the number of patients presenting with AA and the symptomatology during COVID-19 pandemic.

Which simple laboratory test is better to differentiate acute complicated and noncomplicated appendicitis?

Background: To research the perioperative significance of the simple laboratory test values on differentiating complicated acute appendicitis. Methods: The medical records of 216 acute appendicitis patients were examined retrospectively. Patients were divided into two groups according to pathological results (non-complicated (n=157) and complicated (n=59)). The demographic and clinical data, laboratory findings, length of hospital stay, and pathological results were compared between the two groups. Receiver operating characteristics (ROC) curves were performed to analyze the optimal cutoff value of numerical variables which were significantly differed between the group comparisons. Results: The preoperative data were similar in two groups except for age. The length of hospital stay (LOHS) was longer and total/direct bilirubin levels higher in the complicated group (p=0.002, p=0.002, and p=0.002, respectively. The lymphocyte level and amylase level were lower in the complicated group (p=0.02 and p=0.004, respectively). ROC curve analysis showed a cutoff values as follows: total bilirubin ≥0.89 mg/dL, direct bilirubin ≥0.43 mg/dL, lymphocyte≤1.63%, and amylase ≤46.5 U/L. Conclusion: Preoperative higher total and direct bilirubin levels are able to predict complicated appendicitis. Preoperative higher serum amylase levels should not have a place in the differential diagnosis of complicated appendicitis. This means that if serum amylase is elevated in a patient with doubted acute appendicitis, it does not suggest acute complicated appendicitis.

Have acute appendicitis complications increased in children as a result of SARS-CoV-2?

The impact of the SARS-CoV-2 pandemic on healthcare has already been described, since it has caused an increase in diagnostic delay and morbidity. Our objective was to assess its influence on the development of complications in children with acute appendicitis. A retrospective cohort study was carried out. It included acute appendicitis patients under 15years of age treated from January 1, 2019 to December31, 2020. They were classified according to diagnosis date as before the pandemic (B) (January 2019-February 2020) and during the pandemic (D) (March 2020-December 2020). According to operative findings, they were classified as complicated appendicitis (perforated/abscess/plastron/peritonitis) and non-complicated appendicitis (catarrhal/phlegmonous/gangrenous). Demographic data, progression time, and postoperative complications were analyzed. A total of 309 patients were included, 193 (62.5%) in Group B, and 116 (37.5%) in Group D, with an age of 9.2 ± 0.4 and 9.4 ± 0.6 years, respectively (CI = 95%). Diagnostic time was 1.35 and 1.43 days (p>0.05) in Groups B and D, respectively, with ≥ 3 days representing 15.5% of cases in Group B, and 16.4% of cases in Group D (p = 0.84). The proportion of complicated appendicitis was 23.3% in Group B vs. 21.6% in Group D (p>0.05). Postoperative complications were observed in 11.4% of patients in Group B, and in 13.8% of patients in Group D (p>0.05), with intra-abdominal abscess being the most frequent complication in both groups (54.5% of the total complications in Group B vs. 65.5% in Group D; p>0.05). The management of acute appendicitis and its complications in pediatric patients has not been impacted by the SARS-CoV-2 pandemic or the safety measures enforced.

Diagnostic Accuracy of Alvarado Score in Diagnosis of Acute Appendicitis in Patients with Acute Pain Right Iliac Fossa

Background: The gold standard treatment of acute appendicitis is appendectomy. Early surgery reduces a number of complications such as appendicular mass formation, abscess and perforation. However, diagnostic inaccuracy especially in female gender can lead to negative appendectomy because other gynecological diseases have quite similar presentation. The objective of our study is to determine the diagnostic accuracy of Alvarado scoring system in the diagnosis of acute appendicitis in comparison to the gold standard histopathology in patients with acute pain right iliac fossa. Methods: This descriptive Cross-sectional study was carried out on 253 patients with acute pain in right iliac fossa at Surgical Department of MTI, Lady Reading Hospital from 14th July 2020 to 14th January 2021. Results: Mean age was 37 years with standard deviation ± 10.09. 111(44%) patients were male and 142(56%) patients were female. 129(51%) patients were married while 124(49%) patients were unmarried. Based on Alvarado scoring Acute appendicitis was diagnosed in 197(78%) patients and missed in 56(22%) patients. Diagnosis of Acute appendicitis was confirmed by histopathology report in 245(97%) patients while in 8 (3%) patients histopathology did not reveal acute infection. Diagnostic accuracy of Alvarado scoring analyzed with histopathological diagnosis was 78.65%. Conclusion: Alvarado scoring has a sensitivity of 79.18%, specificity 62.5%, PPV 98.47%, NPV 8.92% and diagnostic accuracy of 78.65% in diagnosis of acute appendicitis taking histopathology as gold standard in patients with acute pain right iliac fossa. Keywords: Acute Appendicitis, Alvarado, Histopathology, Diagnostic accuracy

Clinical Outcomes and Prognostic Significance of Early vs. Late Computed Tomography in Acute Pancreatitis

Background and Aim: The prevalence of acute pancreatitis is still high with a mortality rate of 10-20% for the past two decades. Acute pancreatitis can be prognosis with computed tomography (CT) which correlates clinical outcomes, complications, and associated mortality rate. The current study aims were to evaluate the clinical outcomes and prognostic significance of early vs. late computed tomography in acute pancreatitis. Methodology: A cross-sectional study was carried out on 136 consecutive acute pancreatitis patients in the department of Gastroenterology and Radiology, Bahawal Victoria Hospital, Bahawalpur for duration of one year from August 2020 to July 2021. Patients with no abdominal CT due to pregnancy and CT performed after 14 days of pain onset were excluded. All the patients were categorized into two groups; Group-I where CT was performed after 4-5 days of pain onset and Group-II CT performed after 6-14 days of pain onset. The CT findings such as prognostic information, CT severity index and local complications were compared in both group. For data collection and analysis, SPSS version 21 was used. Results: Of the total 136 acute appendicitis patients, 92 (67.6%) were male and 44 (32.4%) were females with an age range of 18 to 60 years. The overall mean age was 42.45± 11.62 years. Group-I had 72 patients (early CT performed) and Group-II had 64 (47.1%) patients of late CT performed. The mean severity index of CT performed in early and late was 5.43±2.31 and 6.59±2.6; p=0.005). The severity index of CT was higher in late-performed computed tomography compared to early perform CT. The persistent organ failure had an almost similar incidence in both early and late CT performed (37.4% versus 48.7%; p&lt;0.125). Late CT performed group majority patients had local complications 82.6% compared to 67.4%; p&lt;0.021. No significant variance was found in surgery, percutaneous drainage need, and mortality (p&gt;0.05). Conclusion: Our study found that early CT does not have a negative impact on the outcome of acute pancreatitis. However, local complications were detected with the onset of symptoms in computed tomography after 5-days. Performing computed tomography before the hospitalization sixth day does not result in earlier intervention. Keywords: Computed tomography, Acute pancreatitis, Clinical outcomes

Features of Diagnostics and Treatment of Acute Appendicitis in Patients &#x0D; of Infectious Hospital

Introduction. Acute appendicitis occupies one of the leading positions in terms of incidence among urgent surgical diseases of the abdominal organs in Russia and in the world. Despite the accumulated experience in the diagnosis and treatment of the disease, a number of challenges still remain, leading to delayed diagnosis and, as a consequence, the development of destructive and complicated forms and deterioration of treatment outcomes. One of these "stumbling blocks" is the differential diagnosis of acute appendicitis and infectious diseases. In addition, acute appendicitis frequently develops together with existing acute and chronic infectious diseases, and appears to be also their complication. In our opinion, the absence of a specific algorithm of actions when dealing with this category of patients may be one of the reasons for unsatisfactory results. In this regard, there is a need to develop such an algorithm.Aim. Improvement of the therapeutic and diagnostic algorithm in relation to patients with OA admitted to infectious diseases hospitals, as well as evaluation of the results of its application.Materials and methods. The article presents diagnostics and treatment results of patients with acute appendicitis hospitalized in an infectious disease hospital, and compares their outcomes before and after implementation of the developed diagnostic and treatment algorithm. The study included 102 patients. The retrospective group included 55 patients with acute appendicitis, which developed together with acute or chronic infectious diseases, treated before implementation of the algorithm. The prospective group consisted of 47 patients treated using the developed algorithm.Results. . Gangrenous forms developed in 25 (45,5%) patients of the retrospective group, and in 8 (17%) patients of the prospective group. Peritonitis complicated the course of acute appendicitis in 53 (96,4%) patients of the retrospective group, while in patients of the prospective group this complication was noted in 25 (53,5%) cases. Purulent forms of peritonitis were noted in 20 (36,4%) patients of the retrospective group, and only in 3 (6,4%) patients of the prospective group. There was also a significant difference in the incidence of appendicular infiltration / abscess. This complication was registered in 11 (20%) patients of the retrospective group, in the prospective group it was noted in 2 (4,3%) patients. Postoperative complications were recorded in 8 (14.5 %) patients of the retrospective group. There were no postoperative complications in patients of the prospective group.Conclusion. The data obtained allow assuming that use of the proposed treatment and diagnostic algorithm in patients with acute appendicitis admitted to an infectious diseases hospital can positively affect timeliness of diagnosis and treatment and, as a consequence, improve treatment outcomes for this category of patients.

The Relationship of Delayed Appendectomy to the Incidence of Surgical Site Infection (SSI) in Acute Appendicitis Patients: A Narrative Review

Acute appendicitis is one of the most common causes of surgery worldwide. Appendectomy is a skeptical surgical intervention associated with the risk of Surgical Site Infection (SSI). The purpose of this analysis was to describe the relationship between delayed appendectomy in acute appendicitis and the incidence of SSI. Reviewers selected articles containing data on the incidence of SSI due to appendectomy delays for 3 to 48 hours from seven databases, namely Pubmed, Nature, SpringerLink, Science Direct, ProQuest, Oxford Open Access Journal, and Cochrane Library. The data source was secondary data from international articles published in 2011 to 2020 based on the PICO criteria. The data obtained were then grouped and synthesized without meta-analysis/Synthesis Without Metaanalysis (SWiM) descriptively. A total of 2,778 articles were collected, of which 24 studies met the inclusion criteria. A total of 4 articles showed an association between appendectomy delay and SSI while the other 20 articles did not show a relationship between the two. There was no relationship between appendectomy delays for less than 48 hours since hospital admission to surgery with the incidence of SSI, however a delayed for more than 48 hours showed a significant value. The results showed there was no relationship between delayed appendectomy for less than 48 hours since the time the patientwas admitted to the hospital until the surgery took place, but a delayed appendectomy delay for more than 48 hours showed a significant relationship with the incidence of SSI. This narrative review supports early surgical intervention of acute appendicitis cases by considering the severity of the patient to avoid other surgical complications.&#x0D; Abstrak&#x0D; Apendisitis akut menjadi salah satu penyebab pembedahan yang paling sering ditemukan di seluruh dunia. Apendektomi merupakan intervensi bedah skeptis yang berhubungan dengan risiko terjadinya Surgical Site Infection (SSI). Tujuan analisis ini untuk mendapatkan gambaran hubungan antara penundaan apendektomi pada apendisitis akut dengan kejadian SSI. Reviewer memilih artikel yang memuat data kejadian SSI akibat penundaan apendektomi selama 3 sampai 48 jam dari tujuh basis data yaitu Pubmed, Nature, SpringerLink, Science Direct, ProQuest, Oxford Open Access Journal, dan Cochrane Library. Sumber data berupa data sekunder dari artikel internasional yang diterbitkan pada tahun 2011 hingga 2020 berdasarkan kriteria PICO. Data yang didapatkan kemudian dikelompokkan dan disintesis tanpa meta-analisis/Synthesis Without Meta-analysis (SWiM) secara deskriptif. Total artikel yang dikumpulkan adalah 2.778 artikel, sebanyak 24 studi memenuhi kriteria inklusi. Sebanyak 4 artikel menunjukkan hubungan antara keterlambatan apendektomi dengan SSI sedangkan 20 artikel lainnya tidak menunjukkan hubungan keduanya.Tidak ada hubungan penundaan apendektomi kurang dari 48 jam sejak masuk rumah sakit hingga operasi dengan insidensi SSI namun penundaan lebih dari 48 jam menunjukkan nilai yang signifikan. Berdasarkan hasil analisis, disimpulkan bahwa tidak terdapat hubungan penundaan apendektomi selama kurang dari 48 jam sejak pasien masuk rumah sakit hingga proses pembedahan berlangsung tetapi penundaan apendektomi lebih dari 48 jam menunjukkan adanya hubungan signifikan terhadap kejadian SSI. Tinjauan naratif ini mendukung intervensi bedah yang cepat pada kasus apendisitis akut dengan mempertimbangkan tingkat keparahan pasien dan untuk menghindari komplikasi pembedahan lain.

Acute Appendicitis and Its Management: A Hospital Based Study

Background: Acute appendicitis is the most common acute surgical condition of the abdomen, which if complicated by perforation or peritonitis has high morbidity and mortality. Aim: The aim of this study is to analyze the presentation, diagnosis and management of acute appendicitis along with the role of conservative management in uncomplicated cases. Materials and Methods: This study was conducted in Govt. Medical College Jammu over a period of one year w.e.f September 2017 to August 2018 and included 120 patients. Diagnosis in the suspected patients was based on history, clinical examination coupled with laboratory investigations and imaging modalities like ultrasound/ CT Scan wherever required. Results: 120 patients of acute appendicitis were treated over the period of one year at our center. Abdominal pain was the most common and constant presentation seen in 112 patients followed by vomiting (82), history of fever (60), history of constipation and distension (20) and another 12 had history of diarrhoea. Six patients (5%) responded favorably to conservative management. Conclusion: Acute appendicitis is a common surgical emergency requiring detailed history and meticulous examination coupled with X-ray and ultrasonography for diagnosis. Appendectomy is the standard procedure of choice and wherever feasible laparoscopic appendectomy offers the advantage of less pain, short hospital stay, earlier return to work and overall cost. Keywords: Acute Appendicitis, Appendectomy, Alvarado Score, Phlegmon, Abscess.

The impact of COVID-19 pandemic on the treatment of acute appendicitis in China

ObjectiveThis research aims to analyze the impact of the novel coronavirus pandemic on the hospital visits of patients with acute appendicitis.MethodsThe retrospective analysis was designed to look at the treatment of acute appendicitis in the Department of General Surgery in Beijing Jishuitan Hospital before and during the COVID-19 pandemic (2019–2020). Data was analyzed by the numbers of patients, sex, age, onset time, fever or not, laboratory examination, imaging test, and treatment. And we analyzed the differences between the “pre-COVID group” and “during-COVID group”.ResultsCompared with the year 2019, the number of acute appendicitis patients has diminished substantially during the COVID-19 pandemic (2020), but the number elevated with the control of the pandemic. Even if we did not find the differences of the treatment before and during the pandemic (P = 0.932), the onset time to emergency was significantly longer (P < 0.001), and more patients had showed fever (P < 0.001) during the COVID-19 pandemic. And the total number of white blood cells and C reactive protein level were significantly higher in 2020 than those in 2019 (P = 0.006, 0.003). And the same result was found in patients with appendiceal fecalith (P = 0.047).ConclusionDuring the pandemic of the new coronavirus pneumonia, the number of patients with acute appendix treatment dropped significantly, mainly because it took longer than before, and the condition was more severe. It can be seen that the new coronary pneumonia has a great impact on the patients’ medical treatment behavior, and the active prevention and treatment of the new coronavirus pneumonia is currently an important and urgent issue.

68 Outcomes of Emergency Appendicectomy At Torbay Hospital During Peak SARS-COV-2 Pandemic

Abstract Introduction SARS-COV-2 has created unprecedented challenges for healthcare systems. As a result, new intercollegiate guidelines have been published in the UK to manage emergency surgeries commencing 25th March 2020. Devon has one of the lowest incidences of Covid-19 in UK. In this study, we report outcomes of emergency appendicectomy at Torbay Hospital during peak COVID-19 pandemic, from 25th March till 26th May 2020. Method This is a single centre retrospective review at Torbay Hospital, Devon. It includes all patients who underwent emergency appendicectomy. Primary outcomes were intra-operative findings, change of operation choice due to revised guidelines, and length of admission. The secondary outcome was 14 days post-operative mortality and morbidity. Results A total of 29 patients, median age 33.1, underwent emergency appendicectomy. 79.3% (n = 23) had a pre-operative SARS-COV-2 nasal swab test, all of which were negative. All appendicectomies were conducted in a non-COVID theatre. Level 3 PPE and precautions were used intra-operatively. The choice of operation was changed in 37.9% (n = 10), from laparoscopic to open as per COVID-19 guidelines. Most patients (86.2%) were discharged from hospital within 5 days of operation. None of the patients or surgeons contracted COVID-19 related infection in 14 days following the operation. Conclusions This study is a snapshot into safety of operative management of acute appendicitis in patients not suspected of COVID-19 infection during first wave of pandemic. However, it will be interesting to see long-term multi-centre comparative studies analysing the effect of surgical management of appendicitis during all three waves of pandemic.