Appendiceal Perforation Research Articles

Diagnostic value of biochemical markers in prediction of perforation in acute appendicitis: a cross-sectional study

Background: Acute appendicitis, despite being the most common surgery, can result in increased morbidity and mortality in the case of perforated appendicitis. Identifying a perforation early can reduce the impact on the patient. Bilirubin, C-reactive protein (CRP), and white blood cell (WBC) count have been shown to indicate perforation in appendicitis. Methods: A cross-sectional analytical study was conducted to observe the association between preoperative bilirubin, CRP, and white cell count with the histological findings of either the presence or absence of perforation of the appendix. The eligibility criteria included all patients above 18 years with appendicitis who were managed surgically in the study hospital, Shree Birendra Hosptial, between 1 December 2021 to 30 May 2022. The study was conducted after the approval from the ethics committee. Results: Out of 150 patients, 112 had open surgery and 38 underwent laparoscopic appendectomy. One hundred thirty-four had non-perforated appendix and 16 cases had perforated appendix. The older age group was associated with appendiceal perforation more than the younger age group. Patients with a duration of symptoms less than 24 h and more than 72 h developed perforated appendicitis less frequently. The odds of encountering perforated appendicitis increased by 2.644 times per 0.972 rise in total bilirubin (P= 0.004) and the odds of encountering perforated appendicitis increased by 6.474 times per 1.868 rise in conjugated bilirubin (P= 0.003). There was no significant difference in total leucocyte count and neutrophil percentage among perforated and non-perforated groups. Conclusion: The diagnostic value of the CRP, total bilirubin, and conjugated bilirubin levels was strong and significant when used in combination rather than their individual performance in the diagnosis of perforated acute appendicitis.

A Novel Deep Learning Approach for the Automatic Diagnosis of Acute Appendicitis.

Background: Acute appendicitis (AA) is a major cause of acute abdominal pain requiring surgical intervention. Approximately 20% of AA cases are diagnosed neither early nor accurately, leading to an increased risk of appendiceal perforation and postoperative sequelae. AA can be identified with good accuracy using computed tomography (CT). However, some studies have found that a false-negative AA diagnosis made using CT can cause surgical therapy to be delayed. Deep learning experiments are aimed at minimizing false-negative diagnoses. However, the success rates reported in these studies are far from 100%. In addition, the methods used to divide patients into groups do not adequately reflect situations in which accurate radiological diagnosis is difficult. Therefore, in this study, we propose a novel deep-learning approach for the automatic diagnosis of AA using CT based on establishing a new strategy for classification according to the difficulties encountered in radiological diagnosis. Methods: A total of 266 patients with a pathological diagnosis of AA who underwent appendectomy were divided into two groups based on CT images and radiology reports. A deep learning analysis was performed on the CT images and clinical and laboratory parameters that contributed to the diagnosis of both the patient and age- and sex-adjusted control groups. Results: The deep learning diagnosis success rate was 96% for the group with advanced radiological findings and 83.3% for the group with radiologically suspicious findings that could be considered normal. Conclusions: Using deep learning, successful results can be achieved in cases in which the appendix diameter has not increased significantly and there is no significant edema effect.

Risk factors for developing intra-abdominal abscess following appendicectomy for acute appendicitis: a retrospective cohort study

BackgroundLaparoscopic appendicectomy is commonly performed in Australia for treatment of acute appendicitis. Intra-abdominal abscess (IAA) is a potential complication following appendicectomy for acute appendicitis. Risk factors for developing post-operative IAA remain controversial and poorly defined. Laparoscopic washout may be performed for patients who develop complication(s) including IAA. The aim of this study was to define risk factors for both the development of IAA and identify patients who may require laparoscopic washout following appendicectomy.MethodsData were obtained from 423 patients who underwent laparoscopic appendicectomy over a five-year period (2012–2017). Clinical (fever, haemodynamics, examination findings), biochemical (white cell count, neutrophil count, C-reactive protein, bilirubin, albumin), radiological (CT free fluid), and operative factors (inflammation, suppuration, free-fluid, perforation, histopathology) collected in the pre-, peri-, and post-operative period(s) were analysed.Results23 (5.4%) patients developed post-operative IAA. Duration of intravenous antibiotics was significantly longer in patients who developed IAA and in those who required laparoscopic washout (p < 0.0001). C-reactive protein (CRP) on admission (p < 0.05) and appendiceal perforation (p = 0.0005) were significantly higher in patients who either developed IAA or needed laparoscopic washout. No clinical or radiological finding predicted either the development of IAA or need for laparoscopic washout.ConclusionElevated CRP on admission may predict the development of post-operative IAA formation or the need for laparoscopic washout post-appendicectomy. Prolonged post-operative antibiotic use appears independent of the development of IAA as well as the need for laparoscopic washout. These data highlight the need for clear guidelines on peri-operative antibiotic use following appendicectomy.

Appendicolith classification: physical and chemical properties of appendicoliths in patients with CT diagnosed acute appendicitis – a prospective cohort study

ObjectiveAppendicoliths are associated with a more complicated course of acute appendicitis and failure of non-operative treatment. We aimed to update the appendicolith classification originally described in 1966 and to assess...

The Role of Vascular Cell Adhesion Molecule-1 (VCAM-1) in Predicting Complicated Appendicitis in Children.

Acute appendicitis is a common abdominal emergency observed in emergency departments (ED). Distinguishing between uncomplicated and complicated appendicitis is important in determining a treatment strategy. Serum soluble vascular cell adhesion molecule-1 (VCAM-1) is an inflammatory biomarker. We aimed to determine the role of VCAM-1 in predicting complicated appendicitis in children. Pediatric patients with suspected appendicitis admitted to the ED were enrolled in this prospective study. Pre-surgical serum VCAM-1 was tested in children with acute appendicitis within 72 h of symptoms (from day 1 to day 3). Serum VCAM-1 levels were further analyzed and compared between patients with and without complicated appendicitis. Among the 226 pediatric appendicitis patients, 70 had uncomplicated appendicitis, 138 had complicated appendicitis, and 18 had normal appendices. The mean serum VCAM-1 levels in patients with perforated appendicitis were higher than in those with simple appendicitis (p < 0.001). On day 1 to day 3, the mean VCAM-1 levels in patients with complicated appendicitis were all significantly higher than in those with uncomplicated appendicitis (all p < 0.001). Serum VCAM-1 levels may be helpful in differentiating uncomplicated and complicated appendicitis in children and could predict appendiceal perforation.

Acute Appendicitis in Children with Hematological Malignancies: The Need for Early Diagnosis and Prompt Treatment—A Single-Center Case Series

Abstract Introduction Appendicitis in patients with hematological malignancies presents with vague symptoms, thus requiring a high degree of suspicion for early diagnosis and treatment to prevent complications. Objectives The aim of this article was to describe the demographic, clinicoradiological, operative findings, and outcomes in patients with acute appendicitis with underlying hematological malignancies. Materials and Methods A retrospective review of pediatric patients with hematological malignancy who developed acute appendicitis was conducted. Medical records of patients were reviewed for patient demographics, disease status, signs, and symptoms at the time of diagnosis of acute appendicitis, and outcome. The laboratory, radiological, and histological findings were retrieved from the hospital records. Results Six (2.4%) patients developed acute appendicitis over the past 8 years among a total of 254 patients treated for hematological malignancies in the unit. Five patients had underlying acute lymphoblastic leukemia (ALL) and one had acute myeloid leukemia (AML). Of the five patients, three were in postremission consolidation, one each in the delayed intensification and maintenance phase of chemotherapy. The child with AML was on induction chemotherapy for the first relapse at the time of diagnosis. Fever and abdominal pain were the common presenting symptoms. Diagnosis was made on ultrasound abdomen in five patients, and one patient was diagnosed on computed tomography. All patients underwent open appendectomy. Two patients had evidence of appendiceal perforation. Three patients had neutropenia at the time of developing appendicitis and underwent appendectomy regardless of the absolute neutrophil count (ANC). Five patients recovered well, and chemotherapy was restarted within 2 weeks of appendectomy. One patient developed a superficial surgical site infection. and one patient with relapsed AML expired due to refractory septic shock. Conclusion Acute appendicitis in patients with hematological malignancies can present with subtle signs and symptoms. Appendectomy can be safely performed irrespective of the ANC.

Controversies and Future Directions in Management of Acute Appendicitis: An Updated Comprehensive Review.

Globally, acute appendicitis has an estimated lifetime risk of 7-8%. However, there are numerous controversies surrounding the management of acute appendicitis, and the best treatment approach depends on patient characteristics. Non-operative management (NOM), which involves the utilization of antibiotics and aggressive intravenous hydration, and surgical appendectomy are valid treatment options for healthy adults. NOM is also ideal for poor surgical candidates. Another important consideration is the timing of surgery, i.e., the role of interval appendectomy (IA) and the possibility of delaying surgery for a few hours on index admission. IA refers to surgical removal of the appendix 8-12 weeks after the initial diagnosis of appendicitis. It is ideal in patients with a contained appendiceal perforation on initial presentation, wherein an initial nonoperative approach is preferred. Furthermore, IA can help distinguish malignant and non-malignant causes of acute appendicitis, while reducing the risk of recurrence. On the contrary, a decision to delay appendectomy for a few hours on index admission should be made based on the patients' baseline health status and severity of appendicitis. Post-operatively, surgical drain placement may help reduce postoperative complications; however, it carries an increased risk of drain occlusion, fistula formation, and paralytic ileus. Furthermore, one of the most critical aspects of appendectomy is the closure of the appendiceal stump, which can be achieved with the help of endoclips, sutures, staples, and endoloops. In this review, we discuss different aspects of management of acute appendicitis, current controversies in management, and the potential role of endoscopic appendectomy as a future treatment option.

Diagnostic value of identifying location and amount of free gas in the abdominal cavity by multidetector computed tomography in patients with acute gastrointestinal perforation

Objective: To evaluate the relationships between the location and extent of diffusion of free intraperitoneal air by multi-slice spiral CT (MSCT) and between the location and size of acute gastrointestinal perforation. Methods: This was a descriptive case series. We examined abdominal CT images of 33 patients who were treated for intraoperatively confirmed gastrointestinal perforation (excluding appendiceal perforation) in the Department of General Surgery, Nanfang Hospital between January and September 2022. We identified five locations of intraperitoneal air: the subphrenic space, hepatic portal space, mid-abdominal wall, mesenteric space, and pelvic cavity. We allocated the 33 patients to an upper gastrointestinal perforation (n=23) and lower gastrointestinal perforation group (n=10) base on intraoperative findings and analyzed the relationships between the locations of free gas and of gastrointestinal perforation. Additionally, we established two models for analyzing the extent of diffusion of free gas in the abdominal cavity and constructed receiver operating characteristic (ROC) curves to analyze the relationships between the two models and the size of the gastrointestinal perforation. Results: In the upper gastrointestinal perforation group, free gas was located around the hepatic portal area in 91.3% (21/23) of patients: this is a significantly greater proportion than that found in the lower gastrointestinal perforation group (5/10) (P=0.016). In contrast, free gas was located in the mesenteric interspace in 8/10 patients in the lower gastrointestinal perforation group; this is a significantly greater proportion than was found in the upper gastrointestinal perforation group (8.7%, 2/23) (P<0.010). The sensitivity of diagnosis of upper gastrointestinal perforation base on the presence of hepatic portal free gas was 84.8% and the specificity 71.4%. Further, the sensitivity of diagnosis of lower gastrointestinal perforation base on the presence of mesenteric interspace free gas was 80.0% and the specificity 91.3%. The rates of presence of free gas in the subdiaphragmatic area, mid-abdominal wall, and pelvic cavity did not differ significantly between the two groups (all P>0.05). Receiver operating characteristic curves showed that when free gas was present in four or more of the studied locations in the abdominal cavity, the optimal cutoff for perforation diameter was 2 cm, the corresponding sensitivity 66.7%, and the specificity 100%, suggesting that abdominal free gas diffuses extensively when the diameter of the perforation is >2 cm. Another model revealed that when free gas is present in three or more of the studied locations, the optimal cutoff for perforation diameter is 1 cm, corresponding to a sensitivity of 91.7% and specificity of 76.2%; suggesting that free gas is relatively confined in the abdominal cavity when the diameter of the perforation is <1 cm. Conclusion: Identifying which of five locations in the abdominal cavity contains free intraperitoneal air by examining MSCT images can be used to assist in the diagnosis of the location and size of acute gastrointestinal perforations.

First report of an appendiceal perforation caused by a migrated biliary stent after orthotopic liver transplantation

The overall incidence of biliary strictures in liver transplanted patients is around 13% [1], mostly located at the biliary anastomosis, occurring from 6 to 12% of cases [2].

A study on the diagnostic and predictive value of neutrophil-to-lymphocyte ratio for early perforation in acute appendicitis

Objective To investigate the predictive value of neutrophil-to-lymphocyte ratio (NLR) for early perforation of the appendix in patients with acute appendicitis (AA). Methods Two hundred and 80eighty patients with the first episode of AA within 48 hours and not yet treated with antibiotics were included in this study retrospectively; divided into two groups by the presence or absence of perforation. The clinical data, traditional inflammatory indexes, and NLR were compared between the two groups. The predictive value of inflammatory indexes on the early appendiceal perforation was explored. Results Patients in the perforated group were older, with higher blood WBC, NEU% and NLR, lower LYM% and PLT, higher serum CRP and PCT, and longer hospitalization time. Multivariate regression analysis revealed that high WBC, NEU%, NLR, CRP, PCT, and low LYM% were independent risk factors for early appendiceal perforation. The ROC curves revealed that the predictive value of WBC, CRP, and PCT for early appendiceal perforation was low. NLR, LYM%, and NEU% had a higher predictive value, with AUC values of 0.947, 0.928, and 0.920, respectively. NLR had the highest predictive value. The diagnostic Cut-off value of NLR is 10.83 with a sensitivity of 0.963, and a specificity of 0.850. Conclusion NLR can be used as an effective and sensitive predictive maker of early appendiceal perforation in AA patients. It is easy to generate from existing routine clinical laboratory testing for AA and can be included in complete blood count (CBC) as a routine or add-on value.

The Diagnostic Accuracy of Hyperbilirubinemia in Predicting Appendicitis and Appendiceal Perforation

The Diagnostic Accuracy of Hyperbilirubinemia in Predicting Appendicitis and Appendiceal Perforation

Predictors of in-hospital appendiceal perforation in patients with non- perforated acute appendicitis with appendicolithiasis at presentation

IntroductionAppendicolithiasis is a risk factor for perforated acute appendicitis. There is limited inpatient data on predictors of progression in appendicolithiasis-associated non-perforated acute appendicitis.MethodsWe identified adults presenting with appendicolithiasis-associated non-perforated acute appendicitis (on computed tomography) who underwent appendectomy. Logistic regression was used to investigate predictors of in-hospital perforation (on histopathology).Results296 patients with appendicolithiasis-associated non-perforated acute appendicitis were identified; 48 (16.2%) had perforation on histopathology. Mean (standard deviation [SD]) age was 39 (14.9) years. The mean (SD) length of stay (LOS) was 1.5 (1.8) days. LOS was significantly longer with perforated (mean [SD]: 3.0 [3.1] days) vs. non-perforated (mean [SD]: 1.2 [1.2] days) appendicitis (p < 0.001). On multivariate analysis, in-hospital perforation was associated with age > 65 years (OR 5.4, 95% CI: 1.4- 22.2; p = 0.015), BMI > 30 kg/m2 (OR 3.5, 95% CI: 1.3–8.9; p = 0.011), hyponatremia (OR 3.6, 95% CI: 1.3–9.8; p = 0.012). There was no significant association with age 25–65 years, gender, race, steroids, time-to- surgery, neutrophil percentage, or leukocyte count.ConclusionGeriatric age, obesity, and hyponatremia are associated with progression to perforation in appendicolithiasis-associated non-perforated acute appendicitis.

Non-operative treatment of acute appendicitis in children: clinical efficacy of amoxicillin-clavulanic acid in a retrospective single-centre study

BackgroundThe success rate of non-operative treatment (NOT) of acute uncomplicated appendicitis (AUA) in children varies from 65% to 95%. There are no recommendations on the appropriate antibiotic therapy.ObjectiveTo determine the...

Role of preoperative in-hospital delay on appendiceal perforation while awaiting appendicectomy (PERFECT): a Nordic, pragmatic, open-label, multicentre, non-inferiority, randomised controlled trial

Appendicectomy remains the standard treatment for appendicitis. No international consensus exists on the surgical urgency for acute uncomplicated appendicitis, and recommendations vary from surgery without delay to surgery within 24 h. Longer in-hospital delay has been thought to increase the risk of perforation and further morbidity. Therefore, we aimed to compare the rate of appendiceal perforation in patients undergoing appendicectomy scheduled to two different urgencies (<8 h vs <24 h). In this pragmatic, open-label, multicentre, non-inferiority, parallel, randomised controlled trial in two hospitals in Finland and one in Norway, patients (aged ≥18 years) with presumed uncomplicated acute appendicitis were randomly assigned (1:1) to an appendicectomy scheduled within 8 h or within 24 h to determine whether longer in-hospital delay (time between randomisation and surgical incision) is not inferior to shorter delay. Patients were excluded in cases of pregnancy, suspicion of perforated appendicitis (C-reactive protein level of ≥100 mg/L, fever >38·5°C, signs of complicated appendicitis on imaging studies, or clinical generalised peritonitis), or other reasons requiring prompt surgery. The recruiters were on-duty surgeons who decided to proceed with the appendicectomy. The randomisation sequence was generated using block randomisation with randomly varying block sizes and stratified by hospital districts; neither physicians nor patients were masked to group assignment. The primary outcome was perforated appendicitis diagnosed during surgery analysed in all patients who received an appendicectomy by intention to treat. The absolute difference in rates of perforated appendicitis was compared between the groups. Complications and other safety outcomes were analysed in all patients who received an appendicectomy. A margin of 5 percentage points was used to establish non-inferiority. This trial was registered at ClinicalTrials.gov (NCT04378868) and is closed to accrual. Between May 18, 2020, and Dec 31, 2022, 2095 patients were assessed for eligibility, of whom 1822 were randomly assigned to appendicectomy scheduled within 8 h (n=914) or 24 h (n=908). After randomisation, 19 (1%) of 1822 patients were excluded due to protocol violation. 1803 patients were included in the intention-to-treat analyses, 985 (55%) of whom were male and 818 (45%) female. Appendiceal perforation rate was similar between groups (77 [8%] of 907 patients assigned to the <8 h group and 81 [9%] of 896 patients assigned to the <24 h group; absolute risk difference 0·6% [95% CI -2·1 to 3·2], p=0·68; risk ratio 1·065, 95% CI 0·790 to 1·435). No significant difference was found between the complication rates within 30 days (66 [7%] of 907 patients in the <8 h group vs 56 [6%] of 896 patients in the <24 h group; difference -1·0% [-3·3 to 1·3]; p=0·39), and no deaths occurred during this follow-up period. In patients with presumed uncomplicated acute appendicitis, scheduling appendicectomy within 24 h does not increase the risk of appendiceal perforation compared with scheduling appendicectomy within 8 h. The results can be used to allocate operating room resources, for example postponing night-time appendicectomy to daytime. The Finnish Medical Foundation, Mary and Georg Ehrnrooth's Foundation, Biomedicum Helsinki Foundation, and the Finnish Government.

Inequities in the Diagnosis of Pediatric Appendicitis in Tertiary Children's Hospitals and the Consequences of Delayed Diagnosis

IntroductionMissed diagnosis (MD) of acute appendicitis is associated with increased risk of appendiceal perforation. This study aimed to investigate whether racial/ethnic disparities exist in the diagnosis of pediatric appendicitis by comparing rates of MD versus single-encounter diagnosis (SED) between racial/ethnic groups. MethodsPatients 0-18 y-old admitted for acute appendicitis from February 2017 to December 2021 were identified in the Pediatric Health Information System (PHIS). International Classification of Diseases, 10th Revision, Clinical Modification diagnosis codes for Emergency Department visits within 7 d prior to diagnosis were evaluated to determine whether the encounter represented MD. Generalized mixed models were used to assess the association between MD and patient characteristics. A similar model assessed independent predictors of perforation. Results51,164 patients admitted for acute appendicitis were included; 50,239 (98.2%) had SED and 925 (1.8%) had MD. Compared to non-Hispanic White patients, patients of non-Hispanic Black (odds ratio 2.5, 95% confidence interval 2.0-3.1), Hispanic (2.1, 1.8-2.5), and other race/ethnicity (1.6, 1.2-2.1) had higher odds of MD. There was a significant interaction between race/ethnicity and imaging (P < 0.0001). Among patients with imaging, race/ethnicity was not significantly associated with MD. Among patients without imaging, there was an increase in strength of association between race/ethnicity and MD (non-Hispanic Black 3.6, 2.7-4.9; Hispanic 3.3, 2.6-4.1; other 2.0, 1.4-2.8). MD was associated with increased risk of perforation (2.5, 2.2-2.8). ConclusionsMinority children were more likely to have MD. Future efforts should aim to mitigate the risk of MD, including implementation of algorithms to standardize the workup of abdominal pain to reduce potential consequences of implicit bias.

Efficacy of endoscopic ultrasound-guided pelvic abscess drainage for pelvic abscesses: A case series study

Background and study aimThis is a retrospective study to evaluate the safety and efficacy of endoscopic ultrasound-guided pelvic abscess drainage (EUS-PAD) in a single hospital setting. Patients and methodsThe referral criteria for EUS-PAD included patients with a pelvic abscess (PA) that was amenable for the procedure. A total of 14 patients with PA treated with EUS-PAD were included in this study. The mean patient age was 57.4 years, and male-to-female ratio was 7:7. Overall, there were six cases of appendiceal perforation, five of rectal cancer and one case each of the diverticular perforation, perianal abscess, and walled-off necrosis. ResultsOverall, 100% of procedures were successful. Clinical success was achieved in 11 patients and they were discharged after EUS-PAD within 21.4 days on an average and the average duration of stent placement before removal was 27.0 days. Of all, six patients achieved complete improvement status where the cause was appendiceal perforation while two and one of the patients were recovered where the causes were post-curative operation for carcinoma and walled-off necrosis, respectively. Eight out of eleven patients who exhibited appendiceal perforation or underwent radical rectal cancer surgery were discharged after an average of 9.4 days post EUS-PAD. Although two patients showed temporary improvement, with perianal abscess and controlled rectal carcinoma, the PA worsened as the primary disease intensified. The PA drainage was ineffective in three patients where two of them had uncontrolled rectal cancer and one had diverticular perforation. ConclusionConclusively, the EUS-PAD is not only a reliable, safe, and efficient alternative to surgical and percutaneous drainage but also a valuable procedure with a high success rate for patients with acute infections, such as those who have had an appendiceal perforation or curative surgery. Poor indications and contraindications for EUS-PAD include uncontrolled gastrointestinal perforation and direct tumor invasion.

A case report of perforated appendicitis with pyoperitoneum in a tertiary care center

Acute appendicitis remains one of the most frequent reasons for emergency hospital admissions and the most common cause of an 'acute abdomen' in young adults. The risk of appendicitis is 8.6% for men and 6.7% for women throughout a lifetime, with the frequency peaking in the second decade of life. In 19% of acute appendicitis cases, there is perforation, and it has a bimodal distribution. Appendiceal gangrene and perforation appear to be caused by the appendiceal lumen being blocked. Gangrenous appendicitis and free bacterial contamination of the peritoneal cavity result from ischaemic necrosis of the appendix wall. Extreme ages, diabetes mellitus, immunosuppressive diseases, and obstruction of the appendix lumen are risk factors for appendix perforation. Advances in radiographic imaging have increased diagnostic accuracy, although the diagnosis of acute appendicitis remains primarily clinical. Ultrasound, computed tomography (CT) scans, and magnetic resonance imaging (MRI) scans are the imaging modalities presently in use. Early appendectomy continues to be the best option and the least contentious treatment for acute appendicitis. The accepted standard of care for perforated appendicitis includes both open and laparoscopic procedures. Antibiotic prophylaxis responds effectively to complicated appendicitis.

Appendicitis predictive score for children younger than 4 years

The clinical presentation of acute appendicitis in infants and young children is nonspecific. The diagnosis is often delayed and is accompanied by high rates of appendiceal perforation. The aim of the present study was to develop an early diagnostic scale for acute appendicitis in children less than 4 years of age. Results: The scale had a high discrimination index area under the ROC curve of 0.96 (95%CI 0.88-0.99), sensitivity of 95.1% (95%CI 86.3-99.0%), specificity of 90.0% (95%CI 55.7-89.5%), positive predictive value of 98.3% (95%CI 90.0-99.7%) and negative predictive value of 75.0% (95%CI 49.4-90.2). Conclusions: In this study, a risk score based on characteristics of children less than 4 years with abdominal pain was developed that may help predict a patient’s risk of developing acute appendicitis. 100 children less than 4 years of age with a presumptive diagnosis of acute appendicitis were retrospectively evaluated in 4 hospitals. The case group comprised 90 patients with histopathological diagnosis of positive appendicitis (with inflammation in the appendiceal wall) while the control group comprised 10 patients with a histopathological diagnosis of negative appendicitis (without inflammation). Epidemiological, clinical, laboratory, and ultrasound variables were screened using Least Absolute Shrinkage and Selection Operator (LASSO) and logistic regression to construct a predictive risk score. Accuracy of the score was measured by the area under the receiver operating characteristic curve. Final model comprised 4 variables (Blumberg's sign, C-reactive protein, neutrophil-lymphocyte index and positive ultrasound). The scale had a high discrimination index area under the ROC curve of 0.96 (95%CI 0.88-0.99), sensitivity of 95.1% (95%CI 86.3-99.0%), specificity of 90.0% (95%CI 55.7-89.5%), positive predictive value of 98.3% (95%CI 90.0-99.7%) and negative predictive value of 75.0% (95%CI 49.4-90.2). In this study, a risk score based on characteristics of children less than 4 years with abdominal pain was developed that may help predict a patient’s risk of developing acute appendicitis.

EVALUATION OF HYPERBILIRUBINEMIA AS A DIAGNOSTIC MARKER FOR ACUTE APPENDICITIS AND ITS ROLE AS A PREDICTOR OF GANGRENOUS/PERFORATED APPENDICITIS

Results: In this study, male (62%) outnumbered females (38%) and overall the mean age was 25.43. The mean total serum bilirubin of all 135 patients was 1.20±0.844mg/dl which was above the normal range (&gt;1.0 mg.dl) considered for the study, hence indicating the presence of hyperbilirubinemia. The mean of direct bilirubin was 0.89±0.71 mg/dl while that of indirect bilirubin was 0.34±0.15 mg/dl. Among the patients with inamed appendix, 22 patients (19%) were found to have elevated bilirubin (&gt;1.0mg/dl). In patients diagnosed with appendicular perforation (n=24), 24 patients had bilirubin elevated (&gt;1.0mg/dl), while only 4 patient (16%) had normal level (&lt;1.0 mg/dl). Sensitivity and specicity of bilirubin in diagnosing acute appendicitis and appendiceal perforation was 80.2% and 79.2% respectively. The Odd's ratio was calculated to be 15.37. Serum bilirubin rout CONCLUSION : inely added to the blood investigation can be useful laboratory investigation for aiding in the diagnosis of acute appendicitis. Can be easily done and cheaply available. Patients with three times the normal bilirubin value and clinical signs of appendicitis and appendicular perforation have higher probability of having complicated appendicitis. Total bilirubin levels were signicantly elevated in patients having gangrenous and perforated(complicated) appendicitis than cases with acute appendicitis. Total bilirubin level as a test for predicting gangrenous or perforated appendicitis is highly sensitive and less specic.

ROLE OF MEAN PLATELET VOLUME IN THE DIAGNOSIS OF ACUTE APPENDICITIS IN GOVERNMENT MEDICAL COLLEGE THIRUVANANTHAPURAM- A CASE CONTROL STUDY

Introduction: Acute appendicitis is a common surgical emergency encountered in the casualty. Delay in diagnosis of acute appendicitis may cause a variety of life threatening complications. Diagnostic difculties may lead to negative appendicectomies or cases of missed appendicitis resulting in complications such as appendiceal perforation or abscess formation. The mean platelet volume (MPV) is a parameter detected during routine blood count and to which clinicians do not usually pay attention. The aim of the study is to assess role of mean platelet volume in the diagnosis of acute appendicitis. To assess the role of Mean Platelet Volume as Objectives: an inammatory marker in the diagnosis of Acute Appendicitis in patients whose post- appendicectomy histopathology reports were conrmatory of acute appendicitis and to determine the relationship between Mean Platelet Volume and Total White Blood Cell count and Neutrophil count in patients with acute appendicitis. It Methodology Study Design: was a Case control study conducted in Government Medical College Thiruvananthapuram involving 82 patients who underwent emergency open appendicectomy and 82 patients posted for elective open appendicectomy. Platele Results: t count was measured in all 164 patients. The sensitivity was 37.8%, specicity 78.05%. Positive predictive value 63.3 and Negative predictive value 55.7, positive likelihood ratio of 1.72 and a negative likelihood ratio of 0.8. Youden Index J is 0.1585. From the current study it is concluded that Conclusion: platelet indice , Mean platelet volume might have a role in the diagnosis of acute appendicitis and might help to avoid possible negative appendicectomies