Lightweight interpretable AI model using multiple blood parameters for emergency diagnosis of acute appendicitis.

Interval appendicitis.

The clinical presentation of Crohn's disease (CD) is heterogeneous, reflecting its involvement of any segment of the gastrointestinal tract. Acute right-lower-quadrant pain in CD can closely mimic appendicitis, creating diagnostic and therapeutic challenges. We report a 33-year-old man with established inflammatory ileocolonic CD in clinical remission on infliximab who presented with recurrent right-lower-quadrant pain and imaging findings consistent with acute appendicitis. Colonoscopy demonstrated only mild inflammatory changes without appendiceal orifice involvement. Though initial medical management with antibiotics led to transient improvement, symptoms recurred, prompting a limited appendectomy. Intraoperative evaluation revealed no active ileal or cecal inflammation. Pathology confirmed acute appendicitis without granulomas or definitive features of CD. The postoperative course was uneventful. This case highlights the importance of careful assessment of CD extent and severity using imaging and endoscopy to guide management decisions. Accurate differentiation between acute appendicitis and flare of CD is essential for optimizing medical therapy and surgical planning while minimizing complications.

Acute appendicitis is a common surgical emergency. Laparoscopic appendicectomy is preferred for faster recovery and less pain, but conversion to open surgery remains necessary in some cases. Most evidence on conversion comes from high-income countries, while data from low- and middle-income settings (LMIC), where resource limitations may influence surgical decisions, are scarce. This study aimed to identify factors associated with conversion in a public, resource-limited Peruvian hospital. We conducted a retrospective cross-sectional study of patients undergoing laparoscopic appendicectomy at a public hospital in Lima, Peru, between 2022 and 2023. Variables were compared between patients requiring conversion and those completing the procedure laparoscopically. Multivariate analyses were performed to identify risk factors. A total of 523 patients were included. Conversion to open appendicectomy occurred in 4 patients (0.76%), primarily due to difficult dissection from severe adhesions, intraoperative hemorrhage associated with equipment malfunction. Multivariate analysis identified adhesions (OR=8.91, 95%CI 1.48-53.42, p=0.017), appendicolith (OR=11.49, 95%CI:1.74-75.69, p=0.001), and intraoperative complications (OR=45.74, 95%CI:6.71-311.55, p < 0.001) as significant factors of conversion. Laparoscopic appendicectomy is safe and effective in public hospitals, even in low-resource settings. Conversion was rare and mainly driven by adhesions, appendicoliths, or intraoperative complications. These findings reinforce that laparoscopic appendicectomy can be reliably performed in LMIC.

Acute appendicitis (AA) is one of the most common surgical conditions presenting as acute abdomen. Delaying appendectomy can increase the risk of perforation. However, patients admitted or treated at night have been found to have higher complication rates compared to those treated during the daytime. This study aims to investigate whether the time of day of laparoscopic appendectomy for AA has a significant effect on morbidity and mortality rates. Patients over 18 years of age who underwent laparoscopic appendectomy for uncomplicated AA at the General Surgery Clinic of Mersin University Hospital between 01.01.2020 and 31.12.2024 were retrospectively reviewed. Patients were analyzed according to age, gender, comorbidities, medication use, operative time, duration of pain, need for postoperative intensive care, preoperative laboratory values, time of diagnosis, postoperative complications, and time of surgery, categorized as daytime (08:00-17:00) and nighttime (17:00-08:00). Postoperative complications were compared between patients operated on during daytime and nighttime. The study was completed with a total of 172 patients. The mean age was 32 (range 18-86). Of the patients, 100 (58.1%) were male. The time of diagnosis was during the day for 78 (45.3%) patients. Based on the time of surgery, 103 (59.9%) were performed during the daytime and 69 (40.1%) at nighttime. Univariate analyses found no statistically significant relationship between postoperative complications and the time of operation. Our study showed that in patients undergoing laparoscopic appendectomy for uncomplicated appendicitis, surgery performed during daytime or nighttime hours yielded similar results in terms of complications.

Definitive and accurate diagnosis of acute appendicitis is essential to reduce morbidity, yet ultrasound demonstrates variable performance which has generally improved over time with advancing technology and user expertise. This study aimed to evaluate the diagnostic accuracy of ultrasound for appendicitis in adults in our institution and document alternative diagnoses detected. We conducted a retrospective review of all abdominal ultrasound examinations performed between January 2021 and December 2021 for patients ≥ 16 years where appendicitis was a clinical query. Reports were categorised as positive or negative based on standardised interpretive phrases. Clinical records, operative findings, histology and follow-up determined true outcomes. Inconclusive examinations (non-visualised appendix) were classified as negative for analysis. The cohort comprised 331 patients (92% female; mean age 28 years). Appendicitis prevalence was 16% (53/331). For the detection of appendicitis, ultrasound demonstrated sensitivity of 60%, specificity 98%, PPV 82% and NPV 93%. Alternative diagnoses (n = 108) were more frequent than appendicitis by 2:1 and included haemorrhagic ovarian events, hydrosalpinx, mesenteric adenitis and other gynaecological or abdominal pathologies. Ultrasound demonstrated modest sensitivity but high specificity for diagnosing appendicitis in adults, consistent with international data when inconclusive cases are included. This shows that in the absence of any ultrasound features, appendicitis is unlikely. Alternative findings were twice as common as appendicitis, highlighting the value of ultrasound as a primary imaging modality for the assessment of patients with right lower quadrant pain.

Response to letter regarding clinical significance of the systemic immune inflammation index in relation to pathology treatment and outcomes in acute appendicitis a retrospective study

Diagnosing acute appendicitis during pregnancy is challenging due to physiological changes and concerns regarding fetal radiation exposure from Computed Tomography (CT). This systematic review and meta-analysis evaluates the diagnostic accuracy and safety of Magnetic Resonance Imaging (MRI) for suspected acute appendicitis, providing an updated synthesis based on a large dataset and modern MRI protocols. Following PRISMA guidelines and PROSPERO registration, we performed a systematic review and diagnostic meta-analysis. Studies involving pregnant women with suspected appendicitis, extractable diagnostic accuracy data (true positives, false positives, false negatives, true negatives), and surgical/histopathological confirmation were included. PubMed, EMBASE, and Cochrane Central were systematically searched until September 3, 2025. Risk of bias was assessed using QUADAS-2, and evidence certainty with GRADE. Statistical analysis used R, employing bivariate random-effects models for sensitivity/specificity, sROC curves, meta-regression, and Deeks' test for publication bias. Thirty-four studies were included. Pooled sensitivity was 0.95 (95% CI: 0.91-0.98; I² = 0%) and pooled specificity 0.97 (95% CI: 0.96-0.98; I² = 55.3%), demonstrating strong diagnostic performance (AUC = 0.961; Diagnostic Odds Ratio = 273.1). A positive MRI result increased post-test probability from 30% to 93%, while a negative result reduced it to 2.2%. QUADAS-2 revealed patient selection and index-test interpretation as common bias sources, particularly in older retrospective studies. Moderate heterogeneity in specificity (I² = 55.3%) was observed, but not explained by gestational age. Deeks' test indicated potential publication bias (p = 0.0024), though pooled estimates remained robust in sensitivity analyses. Non-contrast MRI is a highly accurate and safe diagnostic tool for suspected acute appendicitis in pregnancy, demonstrating performance comparable to CT in non-pregnant populations. We recommend MRI as the standard second-line imaging modality following inconclusive ultrasound findings to enhance diagnostic confidence, minimize fetal radiation exposure, and reduce unnecessary surgical interventions.

ASO Author Reflections: Clinical Implications of Appendiceal Abnormalities Detected Outside Acute Appendicitis.

Background Accurately predicting perforated appendicitis (PA) preoperatively remains challenging. Methods We retrospectively studied appendectomy patients with histopathologically confirmed acute appendicitis (2022-2023) to identify predictors of perforation. The primary outcome was histopathologically confirmed perforated appendicitis. Bayesian univariate analysis and Bayesian logistic regression were performed to estimate risk probabilities, with frequentist analyses conducted for confirmation. Model performance was evaluated using the area under the receiver operating characteristic curve (AUC), sensitivity, and specificity. Results Of 770 patients with histologically confirmed appendicitis, 155 (20%) had PA. Bayesian univariate analysis demonstrated decisive evidence (BF 10 &gt; 100) for several predictors, with C-reactive protein (CRP) (BF 10 = 251 079), age (BF 10 = 828), and lymphocyte percentage (BF 10 = 352) showing the strongest associations. Multivariate Bayesian modeling identified a parsimonious three-variable model comprising CRP, age, and lymphocyte percentage. This model demonstrated good discrimination (AUC 0.78) with high specificity (95.4%) and modest sensitivity (29%). Frequentist analyses confirmed these findings. Conclusion A predictive model incorporating CRP, age, and lymphocyte percentage provides a highly specific tool for ruling in perforated appendicitis. This approach may aid in prioritizing surgical urgency and optimizing perioperative management. Prospective validation is warranted.

Acute appendicitis is one of the most common causes of emergency abdominal surgery, and routine histopathological examination of appendectomy specimens is critical for the detection of incidental neoplasms and non-neoplastic lesions. There is no large-scale, multicenter study on this subject in our country. This study aims to analyze the frequency, distribution, and clinico-demographic relationships of histopathological findings in appendectomy specimens. This multicentre retrospective study analysed adult appendectomy cases from fifteen Turkish hospitals (2017-2025). Histopathology was classified into five categories, and demographic patterns and temporal trends were evaluated. The primary outcome was the distribution of appendiceal pathologies, with emphasis on the incidence of incidental neoplasms. The study included a total of 40,286 adult patients. The average age was 36.01 ± 14.87 years, with 40.2% of patients being female (n = 16,186) and 59.8% being male (n = 24,100). Histopathological distribution: appendicitis 86.7% (n = 34,910, 74.8% uncomplicated, 11.4% complicated), no significant findings 4.8%, non-neoplastic lesions 6.8%, neoplasia 1.7%, other rare findings 0.1%. The neoplasia rate increased significantly with age (Spearman rho = 1.00, p < 0.001); it was 0.8% in the 20s and reached 14% in those aged ≥ 80. Mucinous neoplasms (0.7%) were the most common neoplastic lesions, followed by neuroendocrine tumors (0.5%). Neoplasia was more common in women (2.0%) than in men (1.4%) (p < 0.001). This study is the largest series of appendectomies in Turkey and demonstrates that histopathological examination is indispensable in the detection of incidental neoplasms, especially in elderly patients. These findings support routine histopathological examination and suggest heightened neoplasm awareness, particularly in elderly patients.

To evaluate the clinical features and outcomes of early laparoscopic appendectomy in pediatric patients who developed acute appendicitis following hematopoietic stem cell transplantation (HSCT). This retrospective, single-center study included 10 pediatric patients diagnosed with acute appendicitis after undergoing allogeneic HSCT between 2015 and 2025. Demographics, laboratory values, imaging findings, surgical timing, and outcomes were recorded. Among 737 pediatric HSCT recipients, 10 patients (1.4%) developed acute appendicitis. The median age was 13 years (range: 4-16), and 80% were male. Nine patients had a diagnosis of acute lymphoblastic leukemia and one had aplastic anemia. Appendicitis was diagnosed at a median of 23.5 days post-transplant. Half the patients were severely neutropenic (Absolute neutrophil count = 0) at the time of diagnosis. The most common presenting symptoms were abdominal pain (80%), vomiting (50%), and fever (40%). C-reactive protein was elevated in all cases (median: 61 mg/L). While 40% of the cases were diagnosed by ultrasonography, 60% required computed tomography. All patients underwent early laparoscopic appendectomy within 24 h of diagnosis. Histopathology revealed perforated appendicitis in two patients. There were no perioperative complications. Oral feeding was resumed within 1-6 days (median: 2), and no patients experienced wound infections or surgical delays in further treatment. One patient died due to progression of underlying disease, unrelated to appendicitis. Despite the immunosuppressed state and neutropenia, early laparoscopic appendectomy was safe and effective in pediatric HSCT recipients, supporting its use as a first-line treatment strategy in this population.

Appendicitis microbial analysis showed no major differences between appendix-rectal flora; however, Escherichia coli was statistically significantly more prevalent in patients with acute appendicitis compared with patients without acute appendicitis.

Antibiotics and appendectomy are the mainstays of therapy for acute appendicitis, but wide variation exists in antibiotic choice, duration, and guideline adherence. Despite recommendations favoring narrow-spectrum agents, broad-spectrum antibiotic use remains high. This multi-site quality improvement initiative aimed to implement a standardized care pathway to improve antibiotic stewardship. A multi-disciplinary task force developed and implemented an evidence-based pathway across six hospitals within a large health system. Data were compared for patients treated 12 months before and after implementation. The primary outcome was empirical broad- versus narrow-spectrum antibiotic use. Secondary outcomes included duration of therapy and balancing measures such as length of stay, 30-day readmission, and cost. Among 1,279 patients with acute appendicitis (619 pre- and 660 post-intervention), empirical narrow-spectrum use increased significantly (14.2%-18.5%, p = 0.04), with corresponding decreases in broad-spectrum use (82.1%-78.2%, p = 0.09). Statistical process control charts revealed special cause variation, including sustained increases in narrow-spectrum prescribing. Clinical outcomes were unchanged: no differences were observed in length of stay (1.5 d [IQR: 0.9-2.8] versus 1.6 d [IQR: 0.9-2.9]; p = 0.62), 30-day readmission (7.9% vs. 7.1%, p = 0.60), infection-related readmission (1.1% vs. 1.6%, p = 0.57), or technical direct cost ($4,700 [IQR: $3,712-$6,680] versus $4,559 [IQR: $3,470-$6,759]; p = 0.183). A standardized care pathway significantly improved antibiotic selection for acute appendicitis without negatively impacting outcomes or costs. This initiative illustrates the feasibility of scalable, evidence-informed interventions to promote stewardship across diverse clinical settings.

Pyogenic liver abscess is a rare and under-recognized complication of gangrenous or perforated appendicitis in children. Management typically requires a combination of antibiotic therapy and abscess drainage. Although uncommon in the pediatric population, pyogenic liver abscess is more frequently observed in the elderly people. With an aging population, it is increasingly important for young physicians to recognize its clinical presentation and treatment strategies. This report describes an 11-year-old boy admitted with fever, impaired consciousness, nausea, and vomiting-initially raising concern for meningitis. A CT scan revealed a hepatic abscess and findings consistent with acute appendicitis. Following multidisciplinary consultation, the patient underwent percutaneous drainage of the liver abscess and an appendectomy. His postoperative course was uneventful, and he was discharged with a liver drain in place. Given the limited reliability of history and physical examination in pediatric patients with septic shock-especially in emergency settings-clinicians must maintain a broad differential diagnosis.

Acute appendicitis presenting as acute scrotum in a toddler: A case report

Family decision-making during access to surgical care for children: A qualitative analysis and conceptual framework.

Appendiceal tumors (ATs) are classified by the World Health Organization's (WHO) 5th edition of their categorization of digestive system tumors into four subtypes: mucinous neoplasms, adenocarcinomas, serrated lesions, polyps, and neuroendocrine neoplasms (NENs). Due to their rarity and the lack of data from randomized controlled studies, ATs can be challenging to differentiate in medical practice. Specimens obtained during appendectomies for clinically acute appendicitis typically contain ATs. Most ATs in the European population affect women over 50 years. Neuroendocrine tumors (NETs) are the most common histological type, comprising 54.6%, followed by cystic, mucinous, and serous neoplasms (26.7%) and adenocarcinoma not otherwise defined (NOS) (18.6%). Most findings of ATs on pathologic investigation are benign lesions or small NENs that do not require additional treatment. The development of pseudomyxoma peritonei (PMP), a complicated situation of peritoneal carcinomatosis, may result from the presence of appendiceal mucinous neoplasm (AMN). Over the past few decades, multimodal treatment for abdominal cancers has advanced; however, ATs' clinical diagnosis and management are still debated. This review aims to outline the diagnostic options, molecular-based diagnosis, staging, treatment, and prognostic markers related to ATs.

Operative and non-operative management of acute appendicitis in children: a narrative review.

Acute appendicitis is the most common cause for an acute abdomen worldwide, and laparoscopic appendectomy is the treatment of choice in most regions. Perioperative antibiotic therapy has shown to reduce postoperative complications. Conservative treatment strategies are under evaluation, especially in pediatric cohorts, but are not yet routinely used. Many prior studies have evaluated pathogens and resistance patterns involved in acute appendicitis, finding large differences in geographical distribution and recommended antibiotic agents. This study analyzes the local resistance patterns for acute appendicitis at a single referral center in Germany to optimize antibiotic therapy. A retrospective cohort analysis was performed of 181 histologically confirmed pediatric patients with appendicitis. Items analyzed were symptoms, laboratory, imaging, microbiologic results and management strategies. One hundred thirty-nine microbiologic samples were obtained intraoperatively, rendering 226 isolates of 36 different microbiologic species. The most common pathogens were Escherichia coli (31%), members of the Streptococcus anginosus group (21%), Bacteroides fragilis (15%) and Pseudomonas aeruginosa (9%). Pseudomonas and S. anginosus group were significantly associated with perforation. Resistance rates were high for ampicillin/sulbactam (31%), cefuroxime/ceftriaxone (37%) and ciprofloxacin (51%), mostly due to intrinsic resistance. Resistance to cefuroxime/metronidazole (17%), piperacillin/tazobactam (8%) and meropenem (3%) was low. Perforation, fever and higher C-reactive protein values were linked to resistance against cefuroxime/metronidazole. In our cohort, cefuroxime/metronidazole seems to be an adequate option for uncomplicated and piperacillin/tazobactam for complicated cases.