Cases Of Acute Appendicitis Research Articles

Encountering a lateral pouch acute appendicitis in pediatric age group: case series study

Background: Facing lateral pouch appendicitis (LPA) is unusually encountered by pediatric surgeons, and usually, these cases carry intraoperative challenges due to their unpredictable location and are difficult to locate. Pediatric surgeons should be aware of this and anticipate encountering such cases. Diagnosis of acute appendicitis is based on clinical, laboratory, and imaging modalities. Moreover, the same diagnostic strategy is applied for LPA, but with more challenges since its location sometimes gives atypical presentations, with difficulty in finding the appendix during the ultrasonographic radiological imaging. Case Presentation: A total of three cases of acute appendicitis were presented, which were managed surgically. Intra-operatively, an appendix was found retroperitoneally with its base in the posterior wall of the cecum, while the terminal ileum was set in a retroperitoneal fashion alongside the lateral abdominal wall. This is an unusual location, which carries challenges during dealing with such cases. Conclusion: It was assumed that this is a considerable health concern that needs to be investigated. Clarifying the outcome in these cases, and describing the intraoperative findings, would help us understand the condition. Increase the awareness around the health care community, in order to manage these cases properly in terms of understanding the diagnostic challenges, and surgical interventions, and to prevent or decrease the intra-operative complications.

Luminal and Extraluminal Factors in Normal and Pathological Appendix- A Cadaveric Study from Central Kerala, India

Introduction: Appendicitis is the most common clinical entity among the acute abdominal emergencies. Variations in the position of appendix along with degree of inflammation makes the clinical presentation of the condition notoriously inconsistent. Anatomical knowledge about the organ is thereby mandatory for the clinical assessment and to make a confident diagnosis. Obstructive causes have been found to be responsible in 50-80% cases of acute appendicitis. The way in which the inflammatory process proceeds, still remains a topic of debate. Aim: To study the luminal and extraluminal factors in both normal and pathological appendices. Materials and Methods: This was a cross-sectional descriptive study on gross morphological parameters like frequency of various positions, blood supply of appendix, length of appendix and mesoappendix, gross luminal content conducted on 50 normal and 53 pathological appendices collected from the Departments of Forensic Medicine, Anatomy and Pathology in the Government Medical College, Kottayam, Kerala, India, for a period of one year from April 2013-March 2014. Data entered in the excel sheet was further analysed using Statistical Package for Social Sciences (SPSS) software. Continuous variables were summarised as mean and Standard Deviation (SD) and the significance between their mean variables were analysed using t-test. Results: The most common age group presenting with appendicitis was 15-30 years with male incidence more than female. Appendices were supplied by single artery in 64% and by dual arteries in 36% samples. The average length of normal appendix was 7.8±2.33 cm and pathological appendix was 6.05±1.83 cm. Total 34 (77%) of normal appendices and 9 (81.81%) of pathological appendices showed shortening in length of mesoappendix from the tip of appendix. Common positions in normal and pathological appendices were retrocaecal and pelvic respectively. The most common complication presented in this study was perforation (n=7). Appendices were fixed in 16 (32%) of normal and 12 (22.6%) of pathological appendices. Fixity and complication were commonly associated with retrocaecal position. Conclusion: Appendicitis was more common among the younger age groups. The positions of appendix had no role in initiating the appendicitis. But fixity in particular position played an important role in late presentation thereby favouring complications.

Retracted: Clinical Experience of Diagnosis and Surgical Treatment of 6 Cases of Acute Subhepatic Appendicitis.

[This retracts the article DOI: 10.1155/2022/4969774.].

SIGNIFICANCE OF NEUTROPHIL TO LYMPHOCYTE RATIO IN TREATMENT OF COMPLICATED AND NON- COMPLICATED APPENDICITIS IN A TERTIARY CARE CENTER

Background: Appendicitis is one of the common surgical causes of acute abdomen. In atypical clinical progression and non-availability of radiological backup in primary health set ups or rural areas, surgeons nd difculty in deciding the future plan of management, which can be either conservative or surgical management or to refer the patient to higher centers. Delay in diagnosis or management may lead to perforation or peritonitis and increased morbidity and mortality. Any investigation which can predict acute appendicitis and its complications at an early stage shall be of great help. Neutrophil to Lymphocyte ratio (NLR) can be a good predictor of severity of a case of acute appendicitis. The Objective: present study aims to differentiate non-complicated, acute appendicitis from complicated appendicitis on the basis of Neutrophil to Lymphocyte ratio (NLR). A retrospective study was carried out in the department of Surgery, F Methods: AAMCH in a span of one academic year from July 2020 to June 2021. Total cases in this study were 124. Male to female ratio w Results: as 1.2:1. Most of the patients belong to the age group of 20-30 years. Out of 124 patients, 41 cases were of complicated appendicectomies and 83 cases were uncomplicated ones. The cut-off value of NLR was obtained as 5.550 with sensitivity 85.4%, specicity 68.7%, positive predictive value (PPV) 57.4%, negative predictive value (NPV) 90.5% and accuracy 84.9%. Calculation of NLR pre-operatively can be used for differentiating compli Conclusions: cated appendicitis from uncomplicated ones which will help the surgeons in periphery and rural areas to decide the future plan of management. From our study, we can state that NLR value of 5.550 can be used for this purpose.

Epidemiological-Clinical and Therapeutic Aspects of Acute Appendicitis at the Reference Health Center of Commune III (C.S.Ref CIII) of the District of Bamako

Objectives: It was to determine the epidemiological-clinical and therapeutic aspects of acute appendicitis at the Reference Health Center of Commune III of the district of Bamako. Methodology: This was a prospective study from January 1 to December 31, 2020 including patients operated for acute appendicitis and confirmed at histology and cases of abscess and appendicular plastron. Results: We collected 60 cases of acute appendicitis. They accounted for 17.29% of surgical indications. The average age of our patients was 25.5 years. The male sex was the most represented at 63% with a sex ratio of 1.72. The Pain in the right iliac fossa was the most represented reason for consultation with 76.7%. It was at the type of bite 70% of the cases. On physical examination the defense of the right iliac fossa was present in 96.7%. Digestive signs were marked by nausea 28.4% (17 patients) and vomiting 25% (15 patients). The digital rectal exam was painful to the right of the Douglas fir in 76.7% of our patients. In biology a complete blood count (CBC) performed in all our patients has objectified hyper leukocytosis in 80% of cases. The reactive protein (CRP) performed in 36 patients was elevated with values between 18 and 46 mg/ml. The imaging performed was an abdominal ultrasound that found a roundel image of the appendix with increased size in 65%. Surgical treatment consisted of classical Mac Burney appendectomy in 54 patients (90%). The gesture performed was an appendectomy in all our patients. All our appendectomy parts were sent for pathological examination. This examination classified the parts as non-specific appendicitis in 60%, phlegmonous appendicitis in 22% and catarrhal appendicitis in 18% of cases. Surgical follow-up was simple in 98.4% (59 patients) and morbidity was marked by digestive fistula in one patient. We recorded one case of death (1.6%). Conclusion: Acute appendicitis remains the most common surgical emergency in commune III of the district of Bamako. It is a pathology that can be found at all ages of life. Its morbidity and mortality are low subject to early diagnosis and management.

Horseshoe appendix with double insertion of base: A previously unreported anomaly

Duplication of appendix including horseshoe appendix (HA) is well reported. We present the case of acute appendicitis in a 19-year-old male where we found the appendicular base was doubly inserted into the cecum, and the tip was attached to the cecum at sagittal disposal. Ligation and transection of both bases and tip individually were carried out. This is a previously undescribed variety of appendiceal anomalies in the form of HA with double insertion of the base. This report will be a step toward broadening the horizon of knowledge regarding appendiceal anomalies and better delineation of such anomalies.

Determination of risk factors for conversion from laparoscopic to open appendectomy in patients with acute appendicitis.

Acute appendicitis is the most common cause of surgical emergencies. It can be difficult to distinguish cases of acute appendicitis that should be managed by laparoscopic appendectomy (LA) from those that should be managed by open surgery. This study aimed to prevent the inappropriate choice of technique and associated complications by identifying potential risk factors for conversion from laparoscopic to open appendectomy (OA) at the time of initial surgical assessment. This is a retrospective analysis of patients who underwent laparoscopic exploration for acute appendicitis. The study included patients over 18 years of age between January 2016 and July 2021. Patients were divided into two groups according to the surgical approach: those who underwent a LA and those who initially underwent laparoscopic exploration first and then converted to OA. Demographics, perioperative factors, and outcomes were compared between groups. The study included 634 adults undergoing laparoscopic exploration for an appendectomy. About 80.8% had LA, and 19.2% (n=122) required COA. COA patients' average age was significantly higher than LA patients' (48.5 years vs. 37.8 years, P<0.001). The conversion rate for patients over 65 was 63.8%, compared to 15.6% for those under 65 (P<0.001). COA patients had higher bilirubin levels (36.1% vs. 13.5%, P<0.001), higher American Society of Anesthesiologists (ASA) scores (ASA >2, COA 52.5% vs. LA 7.8%, P<0.001), and a higher need for CT imaging (84.4% vs. 67.6%, P<0.001) than LA patients. An Alvarado score >6 significantly differenti-ated LA from COA (62.6% vs. 39.4%, P< p<0.001). COA patients experienced significantly increased periods until starting oral intake (31.6 vs. 9.9 h, P<0.001) and higher rates of complicated appendicitis (40.9% vs. 0.6%, P<0.001). After surgery, COA had higher rates of complications compared to LA: surgical site infections (8.2% vs. 2.7%, P=0.004), reoperation (13.1% vs. 0%, P<0.001), hospital re-admission (14.7% vs. 2.3%, P<0.001), and mortality (1.6% vs. 0%, P<0.004). Advanced age, especially over 65 years, elevated bilirubin levels, an ASA >2 score, and an increased need for pre-operative diagnostics using CT scans were found to be significant predictors of conversion to OA. In the conversion group, operative time, time to oral intake, and the incidence of complicated appendicitis were significantly higher. The conversion group had significantly higher rates of postoperative complications, surgical site infections, hospital readmissions, and mortality. To avoid the increased rate of complications associated with conversion to open surgery, the initial evaluation of a patient with prospective risk factors may be beneficial.

A case of acute appendicitis cured on the basis of keynote symptom of our materia medica

Acute Appendicitis is sever painful surgical condition. In this patient feels sever pain along with Vomiting/Nausea and Fever.A patient of 25 years present with acute appendicitis. After the proper case taking a most appropriate medicine Ignatia Amara 30 was selected. A proper follow-up record was maintained during the whole treatment process. After 3 weeks the patient was completely relieved.This case study emphasises the value of Keynote homoeopathic prescriptions by suggesting homoeopathic treatment as a workable adjunct or alternative therapy.

Assessment the Incidence, Pattern and Clinical Presentation of Acute Appendicitis at ATAT Hospital

Background: Acute appendicitis is one of the commonest surgical Emergency encountered in both children and adults. The life time risk of developing appendicitis in the USA is 8.6% for males and 6.7% for females with the highest incidence in the second and third decades. The incidence in the United Kingdom is about 52per 100,000 population (Mike, 2015; John, 2008 and Addis, 1990). It is relatively a rare disease in Africa. The incidence is estimated to be less than 9 per 100,000population in South Africa (Richard, 2014). The incidence of the disease is now thought to have increased in African populations which are probably due to the adoption of more western patterns of life. However few studies were done in Ethiopia A retrospective analysis was undertaken on 200 cases of acute appendicitis surgically managed at Yirgalem Hospital from January 1997 to December 1999. During this period the disease accounted for 27.9% of the operations for acute abdominal emergencies and for 1.1% of total hospital admissions. The overall mortality rate of 0.2-0.8% is attributed to the complications of the disease other than surgical interventions .the mortality rate rise above 20% in patients older than 70 years, primarily because of diagnostic and therapeutic delay. Objective: The study aims to assess the incidence, pattern and clinical presentation of acute appendicitis at ATAT Hospital, from december30-january12. Methodology: A retrospective cross sectional study will be conducted at ATAT hospital GURAGE zone surgical patients who were admitted to the surgical ward with the diagnosis of acute appendicitis from meskerem 2009- Pagume 2011E.C. The data will be conducted by reviewing records and data will be analyzed manually. Result: The result will be compared with other studies and will be presented using tables. During the two years of study a total of 342 emergency abdominal emergencies. There were 128 patients presenting at Atat Hospital with acute appendicitis. Out of these, the records of 114 (89.06%) patients were retrieved for analysis remaining cards couldn’t be traced. 8 (7.01%) Of patients had appendicular masses and were managed conservatively, While 106 (92.6%) had emergency surgery for acute appendicitis. Conclusion and Recommendation: Acute appendicitis is the most common cause among all emergency acute abdominal operations performed in Atat hospital. Efficient information, Education and communication strategy needs to be designed to increase the knowledge of the community about appendicitis. Further studies should be made concerning appendicitis during pregnancy.

Impact of COVID-19 Pandemic on Acute Appendicitis Presentation

Objectives: This research aimed to compare the incidence and severity of acute appendicitis (AA) before and during the COVID-19 pandemic. Materials and Methods: Two southern Saudi Arabian high-volume hospitals hosted this retrospective investigation. The COVID pandemic period (March–June 2020) and the pre-COVID period were identified (March–June 2019). The frequency, clinical manifestation, and severity of AA were compared for patients who underwent appendectomies during these periods. Results: In the study hospitals, total admissions decreased by 52.3% (95% confidence interval [CI]: 51.1%–53.3%) from 6231 patients during the pre-COVID period to 3261 patients during the COVID period. In the 2019 study period, 107 cases of AA were surgically treated, compared to 61 cases in 2020. The observed reduction rate was 57.1% (95% CI: 47.5%–66.8%). During the COVID period, the duration from the onset of symptoms to hospital admission and hospital admission to surgery was significantly shorter for patients. There were no significant differences between the COVID and pre-COVID periods in terms of the clinical picture or severity of AA. Conclusions: During the COVID era, there was a significant decrease in the number of AA patients hospitalized, which may indicate the efficacy of home treatment for mild cases. The successful measures taken by the Saudi Arabian government during the curfew, along with the optimal utilization of resources and logistics, resulted in the early presentation and management of AA, yielding results comparable to the pre-COVID era.

Acute phlegmonous appendicitis in rare variant of appendix diverticulum (case report)

Background. Appendicitis-like diverticulitis is considered a rare disease and is usually the subject of clinical reports. Clinical manifestations of this pathology is similar to those of appendicitis, which is why a preoperative diagnosis is made quite rarely. When carrying out the study, we considered a clinical case of acute phlegmonous appendicitis with a rare variant of the appendix wall diverticulum.Material and methods. To assess clinical cases, a retrospective analysis of medical documentation (medical records of patients with diverticulitis in particular) was used. The assessment of clinical symptoms was accompanied by using general clinical, histological and microbiological methods.Results. Patient I., 62 years old, was diagnosed with acute appendicitis. An urgent appendectomy was carried out, during which the vermiform process was removed. It was located retrocecally, in the adhesive process and loose infiltrate. The length of the process is 7–8 cm, its diameter is 1–1,5 cm. 6 diverticula up to 0,7 cm in size are visible. When the process is cut, the pyoid contents protrudes from its lumen. In addition, the appendix removed during appendectomy was sent for pathological study. A standard histopathological study was carried out with the step-like sectioning and hematoxylin and eosin staining.Conclusion. From the results of a pathological study, it was found that the layers of the vermiform process wall with diverticula are diffusely infiltrated by polymorphonuclear leukocytes. The mucous membrane is anesthetized and had ulcerative defects. The patient was diagnosed with phlegmonous appendicitis, periappendicitis, diverticulitis.Vermiform process diverticulitis is not a common pathology, however a timely diagnosis can cause quite severe complications.

The Efficacy of Conservative Management in Uncomplicated Acute Appendicitis - A Single-Center Retrospective Study.

Background Acute appendicitis remains the most common cause of lower abdominal pain leading to emergency visits. Even though the standard treatment of acute appendicitis remains appendectomy, in recent times, multiple randomized control trials and meta-analyses have deduced conservative treatment as a successful alternative treatment.During the coronavirus disease (COVID) pandemic, with a shortage of staff and resources, treatment with conservative management of uncomplicated acute appendicitis became very beneficial under certain circumstances and conditions. This study aimed to assess whether it is effective to manage patients with uncomplicated acute appendicitis with antibiotic therapy. Methodology This was a single hospital based retrospective, cross-sectional study from Jan 2015 to May 2020. Patients with clinical and radiological features of uncomplicated acute appendicitis with Alvarado's score >6 were included in the study. Patients were kept on antibiotics, intravenous fluids, and analgesia as part of a conservative regime. Those who failed to respond to conservative therapy were managed surgically. The follow-up period was six months. Results One hundred eighty-two cases of uncomplicated acute appendicitis were included and managed conservatively, of which 52.2% were males while 47.8% were females. The median age of the patients was 26 years. Conservative treatment was successful in 26.2% of the patients, with a recurrence of 5.5% in the six-month follow-up period. The mean number of days of hospital stay was three days in patients treated with conservativeor surgical treatment. Conclusion Conservative management is gaining popularity, and many centers are inclined towards non-operative management; however, appendectomy remains the gold standard treatment for appendicitis.

Meteorological and demographic factors associated with the onset of acute appendicitis in rural islands of Japan

Emergency surgery and hospitalisation has become a burden in rural areas owing to a shortage of surgeons. Acute appendicitis is a common emergency disease. Understanding the aetiology of acute appendicitis could predict emergency surgeries to optimise resource allocation in rural areas. Several studies have pointed out that some meteorological factors are associated with acute appendicitis; however, there is no consensus about these factors. With the geographical advantages, homogenous meteorological effects, and overwhelming medical data collection in the area, this study aimed to explore meteorological and demographic factors associated with acute appendicitis by focusing on the onset day of acute appendicitis. Miyako islands is in southern Japan and it has a subtropical climate. Okinawa Miyako prefectural Hospital (OMH) is the only hospital in the area that conducts emergency surgery. A total of 212 acute appendectomy cases collected over 6 years were analysed for sex, age, onset date, pathology type, perforation, and fecaliths. Meteorological factors (air pressure, air temperature, humidity, precipitation, wind speed, sunlight hours, and lunar age) on the onset day of acute appendicitis were analysed. Significant differences between air temperature 6 and 7 days before onset and the onset day were observed. Higher air temperature, compared to the average value, was significant in acute appendicitis cases. Pathological types were associated with age group, perforation, and fecaliths. Age group was also associated with existing perforation. Increase in temperature throughout the week prior to onset could be an anticipating factor for the onset of acute appendicitis. The meteorological and demographic features associated with the onset of acute appendicitis could become keys to evaluating acute appendicitis risk in the future and contribute to reasonable allocation of scarce surgical resources to rural areas.

Impacts of COVID-19 on Patients With Common Surgical Emergencies at the King Fahad Specialist Hospital in Buraidah, Saudi Arabia.

The COVID-19 pandemic is a global disaster with millions of infections and deaths. Healthcare systems and services were significantly affected, necessitating adjustments. These included postponement of scheduled appointments and elective surgeries. During the pandemic, there was an increase in the number of acute appendicitis, gallstones, and hernia with a significant impact on the signs and symptoms of presenting problems due to prehospital delay. This study aims to measure the impacts of COVID-19 on patients with common surgical emergencies in King Fahad Specialist Hospital, Buraidah, Saudi Arabia. This is a single-center retrospective study conducted at King Fahad Specialist Hospital in Buraidah, Saudi Arabia. We reviewed all medical records of patients diagnosed with common surgical emergencies (acute appendicitis, gallstones, and hernia) during a selected time of COVID-19 lockdown and compared it with a similar set period before the crisisas a control sample. All medical records were reviewed to find out the overall number of admissions, frequency of emergency department (ED) visits, duration of illness, picture of clinical presentation, intraoperative findings, course and duration of admission, and final pathology if any. A total of 322 patients were included in the study. Of these, 119 (37%) patients underwent surgery before COVID-19while 203 (63%) patients underwent surgery during the pandemic. The diagnosis of acute appendicitis was 63.9% and 47.7%, hernia 27.7% and 34.6%, and gallstone was 8.4% and 17.7% for control and pandemic periods, respectively. The duration varied from 10 hours to two days and four hours to one month, seven hours to one day to eight hours to six months, and two hours to one day to seven hours to one and half a month for acute appendicitis, hernia, and gallstone in control and pandemic period, respectively. The mean length of stay for acute appendicitis was reduced from two days during the control period to one day during the pandemic period, from four to three days for gallstone, and for hernia, it remained three days for both the control and pandemic periods, respectively. Regarding the course of admission for acute appendicitis, the uneventful cases were reducedwhile an increase in uneventful cases for both hernia and gallstone was observed. During the COVID-19 pandemic, there was a noticeable reduction in hospital visits. We observed an increase in the number of one-time visits and a reduction of three, four, and seven-time visits, which was attributed to the fact that patients have been reported to visit the hospital after a long time from the onset of symptoms with a higher chance of complication and subsequent surgeries. The number of acute appendicitis cases was reduced while the cases of hernia and gallstones increased significantly. The minimum period for the duration of acute illness for appendicitis was reduced in the pandemic period, while the minimum period for both gallstone and hernia was increasedas both conditions could requireconservative management. The mean length of hospital stay was reduced during the pandemic period, mainly due to the early discharge implementedin COVID-19 protocols to decrease the risk of infection. The severity of symptoms was increased due to the cancellation and delaying of surgeries.

Changing characteristics of emergency surgery during COVID-19 pandemic: a retrospective cohort study.

In other countries, researchers have noticed diverse variations in the features of patients undergoing emergency surgery during the COVID-19 pandemic. In Mexico, there is not information about this issue. Workers of the Mexican Government, who required emergency surgeries were studied by the general surgery service of a General Hospital administered by the Institute of Social Security and Services for State Workers Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado (ISSSTE), through the periods from March-August 2019 (non-exposed) and March-August 2020 (exposed). The analysis included: demographic data, laboratory information, post-operative diagnoses, symptoms' length, days of emergency stay, and post-operative stay. One hundred and ninety-three emergency surgeries were analyzed; 106 in 2019 and 87 in 2020 (a decrease of 18%). Throughout the pandemic, the number of days between the symptoms' onset and surgery was greater: 2019, 7.6 ± 4.6 days; 2020, 14 ± 6.7 days (p < 0.0001). In addition, cases of acute appendicitis decreased (2019-60.3%; 2020-42.5%), and those of acute calculous cholecystitis increased (2019-12.2%; 2020-24.1%). Through the COVID-19 pandemic, there were notable changes in the characteristics of Mexican Government's workers who warranted emergency surgery.

EVALUATION OF CRP (C-REACTIVE PROTEIN) AND PROCALCITONIN AS DIAGNOSTIC MARKERS IN ACUTE APPENDICITIS

Background: One of the most prevalent abdominal crises is acute appendicitis. Many efforts have been directed towards early diagnosis and intervention. Delay in diagnosis leads to increase morbidity and costs. Present study was aimed to evaluate the correlation of CRP and PCT with perioperative ndings in suspected cases of acute appendicitis and to nd whether they can aid in the diagnosis of acute appendicitis. Material and Methods: Present study was hospital based screening test study, conducted patients of age &gt; 18 years, either gender, who presented with right iliac fossa pain lasting &lt; 48 hours and were tentatively diagnosed with acute appendicitis, underwent surgery. Results: Among 115 patients with acute appendicitis, most of patients belong to age group of 21 to 30 years (45.2 %) followed by 31 to 40 and 10 to 20 years (18.3 %). Out of 115 patients 40 (34.8%) patients were females and 75 (65.2%) patients were males. CRP was positive in 84 (73.04%) and procalcitonin was positive in 66 (57.39%) patients with acute appendicitis. CRP had a sensitivity of 72.82%, a specicity of 25%, a positive predictive value of 89.29%, and a negative predictive value of 9.68 %. Procalcitonin had a sensitivity of 57.28 %, a specicity of 41.67 %, a positive predictive value of 89.39 %, and a negative predictive value of 10.20%. Conclusion: Elevation in CRP as well as procalcitonin levels only cannot be used for nal diagnosis of acute appendicitis, but it can act as an adjunct when evaluating the available clinical and laboratory

Role of Ultrasonography in the Diagnosis of Acute Appendicitis

Introduction: Acute appendicitis is still prevalent as a major surgical emergency. Due to the fast progress of the ailment, surgery is often the most sensible approach to manage it. But any surgery comes with its fair share of risk. If the diagnosis of the disease can be made more accurate prior to surgery, the error rate of negative appendectomy can be greatly reduced. Aim of the study: The aim of the study was to evaluate the role of ultrasonography in the diagnosing acute appendicitis. Methods: This prospective cross-sectional study was conducted at the Department of Surgery, Faridpur Medical College Hospital, Faridpur, Bangladesh. The study duration was 6 months, from November 2013 to April 2014. A total of 100 cases were selected from those admitted to the emergency department of the study hospital with pain in the right lower quadrant of the abdomen for the purpose of this study. Result: Among the 100 participants of the study, histopathological diagnosis showed that 86% were acute appendicitis cases and 14% had normal appendicitis. Gender or age had no significant association with histopathological diagnosis, but male prevalence was observed in the study, with a high prevalence of young adults. The original site of pain was periumbilical pain shifted to the right iliac fossa for half the participants. Pain duration was between 18-24 hours for 36% of the cases. All participants presented with pain, fever, anorexia, and nausea had a high prevalence among participants. The sensitivity and specificity of high-resolution ultra-sonogram were 84.9% and 85.7% respectively. Conclusion: Appendicitis is a disease of the young, and can occur in participants of both genders. Histopathological diagnosis has no significant association with patient age or gender. Ultra-sonogram has high sensitivity and specificity ratio in diagnosing acute appendicitis and also has a high positive predictive value but low negative predictive value.

Estimating the potential overdiagnosis and overtreatment of acute appendicitis in Thailand using a secondary data analysis of service utilization before, during and after the COVID-19 lockdown policy.

Acute appendicitis is one of the most common surgical emergencies; however, optimal diagnosis and treatment of acute appendicitis remains challenging. We used the coronavirus disease 2019 (COVID-19) lockdown policy as a natural experiment to explore potential overdiagnosis and overtreatment of acute appendicitis in Thailand. The aim of this study was to estimate the potential overdiagnosis and overtreatment of acute appendicitis in Thailand by examining service utilization before, during, and after the COVID-19 lockdown policy. A secondary data analysis of patients admitted with acute appendicitis under the Universal Coverage Scheme (UCS) in Thailand over a 6-year period between 2016 and 2021 was conducted. The trend of acute appendicitis was plotted using a 14-day rolling average of daily cases. Patient characteristics, clinical management, and outcomes were descriptively presented and compared among three study periods, namely pre-pandemic, lockdown, and post-lockdown. The number of overall acute appendicitis cases decreased from 25,407 during pre-pandemic to 22,006 during lockdown (13.4% reduction) and 21,245 during post-lockdown (16.4% reduction). This reduction was mostly due to a lower incidence of uncomplicated acute appendicitis, whereas cases of generalized peritonitis were scarcely affected by the pandemic. There was an increasing trend towards the usage of diagnostic computerized tomography for acute appendicitis but no significant difference in treatment modalities and complication rates. The stable rates of generalized peritonitis and complications during the COVID-19 lockdown, despite fewer admissions overall, suggest that there may have been overdiagnosis and overtreatment of acute appendicitis in Thailand. Policy makers could use these findings to improve clinical practice for acute appendicitis in Thailand and support the efficient utilization of surgical services in the future, especially during pandemics.

Perforated appendicitis in infancy

Acute appendicitis is the major indication for abdominal surgery in the pediatric population. It represents 1–2% of all patients admitted into pediatric surgical wards. The clinical manifestations are varied and sometimes atypical due to the nature of the differing pathophysiology and the communicative capabilities of the patients based on age and development. We share a case of acute appendicitis that first presented to our emergency department and admitted under general pediatric medicine; later surgically treated and confirmed using histopathology. The patient's health record was reviewed for the following: demographics, visits, imaging modalities, management, outcome, and histopathology. Our 2-month-old patient was admitted under the general pediatric team who treated him at first under the assumption of incomplete Kawasaki disease. A consultation to pediatric surgery for an infected urachus lead to an Ultrasound and CT-scan studies being done. This was followed by exploratory laparotomy and appendectomy due to the need for drainage and further assessment. The findings which were further confirmed by histopathological specimens were suggestive of acute appendicitis with peri-appendiceal abscess Acute appendicitis in infants is a challenging diagnosis, A high level of suspicion and having knowledge of the red flags specific to abdominal pain and appendicitis in infants could significantly aid in improving diagnostic skills. In addition, early imaging using US in addition to CT is paramount in insuring early recognition and optimal outcomes

Role of hyponatremia in differentiating complicated appendicitis from uncomplicated appendicitis: a comparative study.

Some studies suggest that serum sodium level may decrease at a greater degree in complicated acute appendicitis (CA) because of the increased severity of inflammation. This study aimed to determine the predictive value of some inflammatory markers and hyponatremia in differentiating CA from uncomplicated acute appendicitis (UCA). In this retrospective cohort study, the data of patients who underwent urgent appendectomy in Department of General Surgery, Eskisehir Osmangazi University from January 01, 2016 to January 01, 2021, were analyzed. Patients were divided according to appendicitis type, UCA and CA. In this study, 10.2% (n = 79) of 772 acute appendicitis cases were CA. Multiple logistic regression analysis revealed that high age (p = 0.001), male sex (p = 0.014), high leukocyte count (p = 0.045), low lymphocyte count (p = 0.023) and hyponatremia (p <0.001) were independently associated with CA. Patients with hyponatremia (sodium level ≤134 mEq/L) had 3.050-fold higher risk for CA than patients with normal sodium level (odds ratio: 3.050, 95% confidence interval: 1.668-5.576). The results of the ROC analysis performed to assess the role of sodium level in detecting CA showed a sensitivity of 27.8% and a specificity of 92.1% (cut-off: 133.5 meq/L) (p = 0.001; area under the curve: 0.612 [0.539-0.684]). Clinicians should be aware of the higher likelihood of CA occurrence in patients with appendicitis in whom hyponatremia, leukocytosis, or lymphopenia is detected in the laboratory examination.