Appendicitis Research Articles

Efficacy and safety of endoscopic direct-vision appendicitis therapy in patients with acute appendicitis

Objective: To analyse the efficacy and safety of endoscopic direct-vision appendicitis therapy (EDAT) in patients with acute appendicitis. Methods: The clinical data of patients diagnosed with acute appendicitis and underwent surgical treatment from May 2023 to July 2024 at Zhongda Hospital of Southeast University were analysed retrospectively. The patients were divided into EDAT group (41 cases) and laparoscopic appendectomy (LA) group (630 cases) according to the surgical methods. After 1∶2 propensity score matching (PSM) based on general baseline information, Alvarado score and underlying diseases, the perioperative period and prognosis indicators were compared between the 2 groups. The deadline for follow-up was October 30, 2024. Results: A total of 123 patients were included after PSM, 41 patients in EDAT group, including 21 males and 20 females, aged [M (Q1, Q3)] 55 (37, 61) years; and 82 patients in LA group, including 41 males and 41 females, aged 50 (35, 60) years. A total of 366(221, 492) days were followed up. The operative time [ (38.7±22.3) vs (54.8±16.2) min], postoperative intestinal function recovery time [(2.5±1.3) vs (21.8±5.0) h], duration of antibiotic use [2 (2, 2) vs 3 (3, 4) d] and hospitalisation days [2 (1, 2) vs 3(2, 4) d] in EDAT group were shorter than those in LA group; postoperative visual analogue scale (VAS) score at 6 hours [(3.2±1.3) vs (5.5±1.2) scores] was lower than that in LA group; the proportion of patients with intraoperative bleeding >20 ml [0 vs 61% (50/82)] and proportion of painkiller use [7.3% (3/41) vs 69.5% (57/82)] were lower than those of LA group (all P<0.001). The rate of postoperative recurrence in EDAT group was higher than that in LA group [4.9% (2/41) vs 0, P=0.035]. Conclusion: EDAT is effective and safe in treating patients with acute appendicitis, but patients are at risk of recurrence.

Non-operative Management of Acute Appendicitis: A Narrative Review

Non-operative management of acute appendicitis has seen an increasing trend in the management of acute appendicitis, especially after the Covid-19 outbreak. With better imaging modalities like computerized tomography and better broad-spectrum antibiotics, non-operative treatment of acute appendicitis is now considered as an alternative to appendectomy. This article will investigate the role of non-operative treatment of acute appendicitis in adults and children and compare its efficacy and recurrence rate. We will look at the type and duration of antibiotic therapy. The effectiveness of non-operative treatment is also compared with appendectomy in the treatment of acute appendicitis.

Robot-assisted appendectomy in a child — a case report

BACKGROUND: Acute appendicitis is the most common surgical pathology requiring emergency intervention in children worldwide. The gold standard in the treatment of the disease is laparoscopic appendectomy. At the same time, advances in technology increasingly incline specialists to the introduction of robotic systems in surgical practice. This fact once again confirms the importance of research aimed at determining the feasibility of using robot-assisted appendectomy in emergency surgery in children. CLINICAL CASE DESCRIPTION: The authors made a retrospective review of the medical history of a child with acute appendicitis. A 11-year-old boy was admitted to the Irkutsk State Regional Children's Clinical Hospital with abdominal pain in the right iliac region. At the time of admission, disease duration was 20 hours. For surgery, the Versius robot manufactured by CMR company (UK) was used. Robot-assisted appendectomy followed the same principles as those used in open or laparoscopic approaches: (1) appendix exposure, (2) mesoappendix bipolar coagulation, (3) appendix removal using an endoscopic mechanical stapler. The total surgical time was 30 minutes, out of which the robot installation time was 10 minutes and the main console time was 20 minutes. The entire procedure was performed completely intracorporally and without conversion to laparoscopic or open surgery. There were no any intraoperative problems and complications. The surgery was successful. Patient’s enteral feeding started on the same day after the surgery. He was discharged from the hospital on Day 3 day after the surgery. Ultrasound of the abdominal cavity, performed 1 month later, did not reveal any signs of abnormalities observed at this age. The patient did not complain of any digestive problems during the entire observation period for 3 months after the surgery. CONCLUSION: Robotic appendectomy has its advantages and disadvantages in the treatment of acute appendicitis. Robotics provides faster postoperative recovery of patients, but requires longer time for surgery; besides, it is an expensive surgical intervention. However, over time the robot-assisted appendectomy may become a cost-effective one that will be successfully used by all surgeons, as it happened with laparoscopic appendectomy several decades ago.

Progress in the application of machine learning in CT diagnosis of acute appendicitis.

Acute appendicitis represents a prevalent condition within the spectrum of acute abdominal pathologies, exhibiting a diverse clinical presentation. Computed tomography (CT) imaging has emerged as a prospective diagnostic modality for the identification and differentiation of appendicitis. This review aims to synthesize current applications, progress, and challenges in integrating machine learning (ML) with CT for diagnosing acute appendicitis while exploring prospects. ML-driven advancements include automated detection, differential diagnosis, and severity stratification. For instance, deep learning models such as AppendiXNet achieved an AUC of 0.81 for appendicitis detection, while 3D convolutional neural networks (CNNs) demonstrated superior performance, with AUCs up to 0.95 and an accuracy of 91.5%. ML algorithms effectively differentiate appendicitis from similar conditions like diverticulitis, achieving AUCs between 0.951 and 0.972. They demonstrate remarkable proficiency in distinguishing between complex and straightforward cases through the innovative use of radiomics and hybrid models, achieving AUCs ranging from 0.80 to 0.96. Even with these advancements, challenges remain, such as the "black-box" nature of artificial intelligence, its integration into clinical workflows, and the significant resources required. Future directions emphasize interpretable models, multimodal data fusion, and cost-effective decision-support systems. By addressing these barriers, ML holds promise for refining diagnostic precision, optimizing treatment pathways, and reducing healthcare costs.

Diagnostic Utility of Spectral Doppler Ultrasound in Acute Appendicitis: a Prospective Study

Diagnostic Utility of Spectral Doppler Ultrasound in Acute Appendicitis: a Prospective Study

A Comparative Analysis of Scoring Systems and MRI for Diagnosing Acute Appendicitis in Pregnant Patients.

Acute appendicitis (AA) represents the most prevalent indication for general surgical intervention during pregnancy. Despite the development of scoring systems for AA diagnosis, their validation in pregnant patient remains incomplete. Given the growing utilization of magnetic resonance imaging (MRI), evaluating the accuracy of both scoring systems and MRI in diagnosing AA during pregnancy becomes essential. We identified pregnant patients who underwent MRI for suspected AA between 2013 and 2023. Patients were categorized into AA and control groups based on established other diagnoses or spontaneous resolution of their symptoms. A national database was used to ensure patients who did not seek further medical attention. The Alvarado, Tzanakis, RIPASA, AIR scoring systems, and MRI findings were compared between the two groups. 180 pregnant patients underwent MRI for suspected AA and 28 were diagnosed with AA upon pathology examination. Most patients in the AA group exhibited negative clinical scores (Alvarado 82%, Tzanakis 84%, RIPASA 68%, and AIR 43%). MRI was positive in 79%. Demographic characteristics and clinical presentations were similar between the AA and control groups. The positive predictive values (PPVs) of clinical scores were modest (Alvarado-38%, Tzanakis-57%, RIPASA-22%, and AIR-12%), whereas the negative predictive values (NPVs) were high (80%-86%) across all scoring systems. MRI demonstrated a PPV of 62% and an NPV of 96%. Despite significant clinical and radiological advancements, diagnosing AA in pregnant patient remains challenging. The discrepancy between clinical scores and MRI finding underscores the complexity of AA diagnosis during pregnancy.

Postoperative Antibiotics After Appendectomy for Acute Appendicitis: No Evidence of Benefit, Even with Intra-Abdominal Fluid.

To evaluate the necessity of postoperative antibiotics following appendectomy for acute appendicitis, particularly in patients with intra-abdominal fluid, and to identify factors associated with postoperative infections. Postoperative antibiotic use after appendectomy remains controversial, especially in the presence of intra-abdominal fluid. While some surgeons prescribe antibiotics empirically, there is no consensus on whether they reduce the risk of postoperative infections in patients with intra-abdominal fluid accumulation. A retrospective study was conducted at Saint Antoine Hospital (2013-2020) analyzing 1,539 patients with acute appendicitis (abscess and peritonitis were excluded). The presence of intra-abdominal fluid, antibiotic use, and postoperative outcomes were recorded. Risk factors for infections were identified through univariate and multivariate analysis. Intra-abdominal fluid was present in 880 patients(57.2%), with 474 exhibiting sero-sanguinous intra-abdominal fluid and 406 presenting purulent intra-abdominal fluid. Postoperative antibiotics were administered to 18.1% of patients, yet no significant difference in infection rates was found between patients with and without peritoneal intra-abdominal fluid . The study identified three independent risk factors for postoperative infection: ASA score (HR=5.129,P=0.004), symptom duration>2 days (HR=2.290,P=0.029), and the presence of appendicolith (HR=2.204,P=0.042). Postoperative antibiotic use did not significantly prevent infections, but inadequate antibiotic therapy was associated with higher rates of readmission and infectious outcomes. Routine use of postoperative antibiotics for acute appendicitis, even with intra-abdominal fluid may not be necessary. Further research is needed to determine whether a targeted antibiotic approach based on risk factors for postoperative infections can improve outcomes without exacerbating antibiotic resistance.

Routine Laparoscopic is Better Than Open Appendectomy: A Reason

Aim: In this study we compare the outcomes of routine laparoscopy and laparoscopic appendectomy in patients with suspected appendicitis. Method: Patients managed with routine laparoscopy and LA for suspected acute appendicitis. All preoperative and intraoperative findings records were Maintained. The clinical outcomes were compared with those of patients undergoing OA in the preceding in one year. Result: During the LA study period, 100 patients (47 men) with the median age of 32 years (range, 17 to 78) presented with clinical features of acute appendicitis. During the OA period, 120 patients (55 men) with the median age of 42 (range, 19 to 79) years were operated on. The median durations of surgery in Group A and Group B were 80 minutes (range, 40 to 195) and 60 minutes (range, 25 to 260), respectively (P&lt;0.005). Postoperative complication rates were comparable between the 2 groups (13.4% in Group A versus 15.8% in Group B). The median hospital stay for patients in Group A and Group B were 2.0 days (range, 1 to 47) and 4.0 days (range, 1 to 47), respectively (P=0.037). Conclusions: We conclude that routine laparoscopy and LA for suspected acute appendicitis is safe with shorter hospital stay. Other intra-abdominal pathologies can also be diagnosed more accurately with the laparoscopic approach.

Assessing the utility of FDG PET/CT study in diagnosis of early acute appendicitis

Assessing the utility of FDG PET/CT study in diagnosis of early acute appendicitis

Acute Appendicitis, Diagnostic and Therapeutic Aspects at the Ouelessebougou Reference Health Center Mali

Object: To describe the diagnostic and therapeutic aspects of acute appendicitis at the Reference Health Center of Ouelessebougou. Methodology: This was a retrospective and analytical study, carried out in the surgery department of the reference health center of Ouelessebougou from January 01, 2019 to December 31, 2019. All patients operated on for acute appendicitis were included in this study. Results: Eighty-three (83) patients were listed, representing 18% of surgical procedures. These were 65 men (78.3%) and 18 women (21.7%), the sex ratio was 3.61. The mean age was 25.61 years with extremes of 3 years and 68 years, Standard Deviation =16.11. Most of the patients, 91.56%, were recruited in an emergency. Clinical signs were dominated by iliac fossa pain in 84.4% of cases, defense in the right iliac fossa in 94% of cases, and right pain in the cul de sac of Douglas fir in 86.8% of patients. The mean duration of the disease was 2.5 days with extremes of 1 to 7 days. Neutrophilic polynuclear leukocytosis was noted in 57.8% of cases. C-reactive protein was elevated in 62.7% of patients. Abdominal ultrasound performed in 78 patients (94%) revealed acute uncomplicated appendicitis in 70 patients (89.7%). Traditional medications were used in 21 patients (25.3%). Appendectomy with burial of the stump was performed in 82 patients (98.8%), and the appendix was laterocecal in 74 patients (89.2%). The postoperative follow-up was simple in 96.4% of cases. Morbidity was 3.6% (3 cases). The mean length of hospital stay was 5.36 days with extremes of 3 days and 8 days. The average cost of care was 62,500 CFA francs with extremes of 25,000 and 80,550 CFA francs. Conclusion: Appendicitis is a common surgical emergency in our department. Delay in consultation and traditional medication are the factors of severity.

Acute appendicitis in children - review focused on diagnostics and treatment

Acute appendicitis in children - review focused on diagnostics and treatment

The Acute Abdomen: Structured Diagnosis and Treatment.

The acute abdomen is a life-threatening clinical entity that requires immediate diagnostic evaluation and appropriate treatment. 15-20% of emergency room patients with acute abdominal pain need interventional or surgical treatment. This narrative review is based on publications retrieved by a PubMed search, current textbooks and guidelines, and the authors' personal experience. The acute abdomen presents with the sudden onset of maximally intense abdominal pain, sometimes with guarding, and often with impaired general well-being, ranging to manifestations of shock. Its more common causes, aside from nonspecific abdominal pain (30-41%), are acute appendicitis (8-30%), cholecystitis (9-11%), and ileus (4-5%). The diagnosis is established by the history and physical examination, laboratory tests, imaging studies, and, in some cases, exploratory laparoscopy. The acute abdomen is generally a surgical condition, but it often requires interdisciplinary, multimodal treatment and follow-up. It carries a 2% to 12% mortality, with the figure rising for every elapsed hour until specific treatment is provided. Structured, quality-controlled, rapid, and targeted diagnosis and treatment markedly lower the morbidity and mortality of patients presenting with an acute abdomen.

A rare complication after transabdominal preperitoneal hernia repair: Acute appendicitis.

A rare long-term complication of transabdominal preperitoneal (TAPP) repair is mesh-induced appendicitis, of which only five cases have been described in the literature. We aimed to present our case of mesh-induced acute appendicitis after TAPP hernia repair. A 25-year-old male presented with a 2-day history of right iliac fossa pain, nausea and appetite loss. He had undergone TAPP repair for a right inguinal hernia 2 years earlier. Imaging revealed an inflamed appendix adhered to the TAPP mesh. Diagnostic laparoscopy confirmed the entrapment and inflammation of the appendix. The patient underwent a successful laparoscopic appendectomy and recovered without complications. Histopathology showed chronic inflammation. To prevent the development of appendicitis after TAPP operation, surgical repair of peritoneal openings is important to prevent such rare complications.

Diagnostic value of the derived neutrophil-to-lymphocyte ratio for acute appendicitis.

The diagnosis of appendicitis in children can present several challenges, leading to an increased risk of complications. Herein, we aimed to evaluate the diagnostic value of the derived neutrophil-to-lymphocyte ratio (dNLR) as a novel adjunctive diagnostic tool for appendicitis. Diagnostic study of patients with appendicitis and non-surgical abdominal pain (AP) admitted to our hospital between 2020 and 2022. White blood cell count (WBC), neutrophil-to-lymphocyte ratio (NLR), and dNLR were compared between the two groups of patients. Overall, 202 patients were enrolled: 101 with appendicitis (69% male, age 9.9 years) and 101 with AP (56% male, age 9.4 years). WBC, NLR, and dNLR were higher in patients in the appendicitis group than in those in the AP group (16.47 versus 11.18 × 103 cells/mm3; 9.5 versus 3.3; and 5.2 versus 2.3; P ≤ 0.0001, respectively). The sensitivity, specificity, positive predictive value, area under ROC curve, and cutoff point of dNLR for the diagnosis of appendicitis were 71%, 74%, 73%, 0.811, and 3.78, respectively. The positive likelihood ratios for WBC, NLR, and dNLR were 1.95, 2.05 and 2.77. dNLR is a novel and noninvasive biomarker with high accuracy for diagnosing appendicitis. Its inclusion as an additional diagnostic tool in clinical practice may aid in determining the need for further studies in cases with ambiguous presentations and a dNLR value ≥3.78.

When 'winner winner chicken dinner' turned into a catastrophe: Intestinal perforation, a case of acute abdomen, a clinical case study.

Intestinal perforation due to an ingested foreign body is a serious complication; although it is often misdiagnosed, while treatment gets delayed due to non-specific symptoms. The present case report describes the case of small bowel perforation due to an ingested chicken bone wherein a 35-year-old female patient presented to the emergency department with a complaint of lower abdominal pain for 2 days. Based on history and symptom review, initially, a working diagnosis of a case of the ruptured haemorrhagic cyst was given, while the ultrasonography findings of the abdomen and pelvis, also, pointed towards a similar diagnosis. As the symptoms worsened, a computed tomography (CT) scan of the abdomen was advised to rule-out acute appendicitis, although, the CT findings revealed a foreign body perforating the small bowel. The patient was subsequently advised laparoscopy-assisted foreign body removal with segmental jejunal resection and an end-to-end anastomosis. The patient had an uneventful post-operative recovery, and was eventually, discharged on the 2nd post-operative day.

Development and validation of automated three-dimensional convolutional neural network model for acute appendicitis diagnosis

Rapid, accurate preoperative imaging diagnostics of appendicitis are critical in surgical decisions of emergency care. This study developed a fully automated diagnostic framework using a 3D convolutional neural network (CNN) to identify appendicitis and clinical information from patients with abdominal pain, including contrast-enhanced abdominopelvic computed tomography images. A deep learning model—Information of Appendix (IA)—was developed, and the volume of interest (VOI) region corresponding to the anatomical location of the appendix was automatically extracted. It was analysed using a two-stage binary algorithm with transfer learning. The algorithm predicted three categories: non-, simple, and complicated appendicitis. The 3D-CNN architecture incorporated ResNet, DenseNet, and EfficientNet. The IA model utilising DenseNet169 demonstrated 79.5% accuracy (76.4–82.6%), 70.1% sensitivity (64.7–75.0%), 87.6% specificity (83.7–90.7%), and an area under the curve (AUC) of 0.865 (0.862–0.867), with a negative appendectomy rate of 12.4% in stage 1 classification identifying non-appendicitis versus. appendicitis. In stage 2, the IA model exhibited 76.1% accuracy (70.3–81.9%), 82.6% sensitivity (62.9–90.9%), 74.2% specificity (67.0–80.3%), and an AUC of 0.827 (0.820–0.833), differentiating simple and complicated appendicitis. This IA model can provide physicians with reliable diagnostic information on appendicitis with generality and reproducibility within the VOI.

Role of conservative management of acute appendicitis in pediatric age: a monocentric experience.

Historically, appendectomy was the standard treatment for acute appendicitis (AA). Recently, interest has grown in conservative management of uncomplicated AA (UA). This study compared outcomes between non-operative management (NOM) and appendectomy, exploring preoperative factors to guide optimal UA management. In a monocentric retrospective study, we reviewed data on 774 pediatric patients with a primary diagnosis of AA from July 2017 to July 2022. We analyzed demographic, clinical, laboratory, and ultrasound data at first and last admission. Operated patients were stratified by management type and surgery timing. Minimum follow-up was 6months. Of the 530 children (68.5%) who underwent surgery at first admission, 316 had UA and 214 had CA. The 244 patients (31.5%) not indicated for surgery received intravenous antibiotics. Of these, 104 underwent appendectomy at second admission, with 9 presenting CA, requiring multiple antibiotic therapy and a hospital stay of 9.1 ± 3.1days. Twenty-eight underwent surgery at their third admission and 112 never underwent surgery. In conclusion, more invasive approach may be preferable for patients with significant clinical signs at first presentation, minimizing hospital stay, costs, antibiotic use, and complications. Further studies on NOM in acute appendicitis are essential to optimize its use.

Liver abscess due to appendicitis: a case report

Pyogenic liver abscess (PLA) is a rare but serious condition that can be life-threatening. Recent developments in diagnostic techniques and treatment have resulted in earlier detection and intervention and hence reduction in mortality rates. Despite these improvements, PLA remains a clinical challenge due to its hidden symptoms and associated health risks. PLA may be caused by seeding from appendicitis. We present a 52-year-old woman presented with PLA due to appendicitis. Upon physical examination, laboratory study and imaging, an acute appendicitis with pyogenic liver abscess were found. The patient underwent percutaneous drainage of the abscesses with a catheter and an interval appendectomy.

Three-year follow-up of antibiotics versus placebo in adults with CT-confirmed uncomplicated acute appendicitis: a secondary analysis of the APPAC III randomized clinical trial.

Three-year follow-up of antibiotics versus placebo in adults with CT-confirmed uncomplicated acute appendicitis: a secondary analysis of the APPAC III randomized clinical trial.

PAN-Immune inflammation value: a new biomarker for diagnosing appendicitis in children??

BackgroundThis study investigates the potential of the pan-immune-inflammation values (PIV) index as a biomarker for diagnosing acute appendicitis in children and compares its performance with other systemic inflammatory markers.MethodsA retrospective analysis of 1,514 pediatric patients aged 0–18 years with abdominal pain admitted between 2019 and 2023 was conducted. Patients were categorized into complicated, non-complicated appendicitis, negative appendectomy, and non-surgical treatment groups. Demographic and laboratory data were recorded, and PIV, Systemic Inflammation Index (SII), Systemic Inflammation Response Index (SIRI), Neutrophil-to-Lymphocyte Ratio (NLR), and Platelet-to-Lymphocyte Ratio (PLR) indices were calculated. Receiver Operating Characteristic (ROC) analysis was used to assess predictive performance, with optimal cut-offs evaluated for sensitivity, specificity, and multiple logistic regression (MLR) analyses.ResultsBased on Area Under the Curve (AUC), C-reactive Protein (CRP), lymphocyte, and PLR showed weak predictive value, while White Blood Cell Count (WBC), neutrophil, monocyte, NLR, SII, SIRI, and PIV demonstrated poor predictive value for appendicitis. Optimal cut-offs were 3.40 for NLR, 134.5 for PLR, 1010.3 for SII, 3.47 for SIRI, and 919.3 for PIV, with sensitivity and specificity values of 78.7%, 47.1% for NLR; 64.7%, 47.5% for PLR; 75.6%, 52% for SII; 71.5%, 57.3% for SIRI; and 72.2%, 54.1% for PIV. In the MLR model, PIV above 919.3 increased appendicitis likelihood 2.67-fold (95% Confidence Interval: 2.16–3.37).ConclusionAlthough PIV demonstrated potential as a novel biomarker for pediatric appendicitis, its diagnostic utility remains limited without supplementary clinical and radiological data. Larger prospective studies are recommended to validate these findings and improve clinical decision-making. PIV may serve as a supplementary tool in diagnosing pediatric appendicitis when used alongside other markers and diagnostic methods.Trial registration‘retrospectively registered’.