Cases Of Acute Appendicitis Research Articles

Comparative Analysis of Acute Appendicitis Cases During and Prior to the Pandemic

Aim: This study aimed to compare the clinical characteristics, morbidity, and diagnostic accuracy of imaging modalities in acute appendicitis cases during the COVID-19 pandemic and the pre-pandemic period. Materials and Methods: We retrospectively analyzed the records of 898 patients who underwent surgery for acute appendicitis between April 2019 and April 2021. The study population was divided into two groups: pre-pandemic (n=508; April 2019 to April 2020) and pandemic (n=390; April 2020 to April 2021). We compared the socio-demographic characteristics, clinical features, morbidity rates, and the diagnostic accuracy of ultrasonography (USG) and computed tomography (CT) between the two periods. Results: The prevalence of complicated cases was significantly higher during the pre-pandemic period (29.3%) compared to the pandemic period (15.6%). The morbidity rate was also significantly higher in the pre-pandemic period. ( p= 0,004) The sensitivity of USG in diagnosing appendicitis decreased during the pandemic period, while CT scans remained more sensitive than USG in both periods. (sensitivity = 0.93, specificity = 0,67) The prevalence of chronic diseases was significantly higher during the pandemic period. Conclusion: Our study revealed that the prevalence of complicated appendicitis cases was significantly higher during the pre-pandemic period compared to the pandemic period. Additionally, the sensitivity of ultrasonography in diagnosing appendicitis decreased during the pandemic, while CT scans maintained their sensitivity across both periods. Based on our findings, we can confidently conclude that the pandemic does not exacerbate the severity of acute appendicitis cases.

A prospective observational comparative study to compare the diagnostic efficacy of the Fenyo Lindberg scoring system and Yash scoring system in patients of acute appendicitis in tertiary care hospitals in central India

Background Acute appendicitis is a typical surgical emergency requiring prompt and accurate diagnosis for timely intervention. This prospective observational comparative study aims to assess the diagnostic efficacy of two scoring systems, the Yash scoring system and the Fenyo-Lindberg scoring system, compared to the gold standard of histopathological diagnosis. The study is conducted at A.V.B.R.H., a tertiary care hospital in Central India, focusing on providing valuable insights into the comparative performance of these scoring systems in the local patient population. Methods The study adopts a prospective observational comparative design, enrolling clinically diagnosed cases of acute appendicitis from the outpatient and inpatient departments of the Surgery department at A.V.B.R.H. Patients willing to undergo surgery are included. At the same time, those with complicating factors or contraindications are excluded. Data collection involves thorough clinical evaluations, scoring system assessments, and comprehensive investigations, with histopathology as the reference standard. Statistical analyses include descriptive statistics, comparative analyses, primary outcome assessments, and regression analyses, ensuring a robust evaluation of the diagnostic efficacy of the scoring systems. Expected Outcome Anticipated outcomes include a comprehensive understanding of the diagnostic efficacy of the Yash and Fenyo-Lindberg scoring systems in acute appendicitis. The study aims to identify which scoring system demonstrates superior accuracy, sensitivity, and specificity, providing valuable information for clinical decision-making. The results will contribute to optimizing diagnostic protocols for acute appendicitis, potentially influencing patient management and surgical interventions. This study’s findings are expected to be relevant to the local setting and broader contexts, enhancing the knowledge surrounding acute appendicitis diagnosis.

The impact of surgical timing on outcome in acute appendicitis in adults: a retrospective observational population-based cohort study.

Acute appendicitis is a global disease with high incidence. The main objective was to assess the association between time from admission to surgery (TAS) and surgery during emergency hours with operative outcome in light of conflicting evidence. This is a retrospective population-wide analysis of hospital billing data (2010-2021) of all adult patient records of surgically treated cases of acute appendicitis in Germany by TAS. The primary outcome was a composite clinical endpoint (CCE; prolonged length of stay, surgical site infection, interventional draining after surgery, revision surgery, ICU admission and/or in-hospital mortality). Cases of complicated appendicitis were identified using diagnosis (ICD-10) and procedural codes (resection beyond appendectomy). 855694 patient records were included, of which 27·6% (236,481) were complicated cases of acute appendicitis. 49·0% (418,821) were females and median age was 37 (interquartile range 22·5-51·5). Age, male sex, and comorbidity were associated with an increased proportion of CCE and in-hospital mortality. TAS was associated with a clinically relevant increase of CCE after 12h in complicated appendicitis [Odd's ratio (OR), 1·19, 95% CI: 1·14-1·21] and after 24h in uncomplicated appendicitis (OR 1·10, 95% CI: 1·02-1·19). Beyond the primary endpoint, the proportion of complicated appendicitis increased after TAS of 72h. Surgery during emergency hours (6 pm-6.59 am) was associated with an increase of CCE and mortality (OR between 1·14 and 1·49). Age, female sex, night-time admission, weekend admission, a known previous surgery, obesity, and therapeutic anticoagulation were associated with delayed performance of surgery. This work found an increase of a CCE after TAS of 12h for complicated appendicitis and an increase of the CCE after TAS of 24h for uncomplicated appendicitis with a stable proportion of complicated appendicitis in these time windows. Both CCE and mortality were increased if appendectomy was performed during emergency hours.

Acute appendicitis in adults: only clinical and laboratory diagnostics, only imaging, or both?

The presented article is devoted to the discussion of the necessity and expediency of using medical visualization diagnostics — radiological imaging — of acute appendicitis as an independent or complex approach in combination with clinical and laboratory data. Until now, the clinical diagnosis of each individual case of acute appendicitis is complicated, and its formulation requires combining clinical, laboratory and imaging data, since it includes a wide range of differential diagnoses depending on age and gender. The literature provides data that the frequency of negative appendectomies based on the results of a clinical examination can be up to 28.2%. Radiological imaging is used as an adjunct to clinical diagnostics using ultrasound examination, computed tomography and magnetic resonance imaging, but the role of the latter is limited by the duration of the study, increased cost, unavailability around the clock, as well as the presence of absolute contraindications. Sonography and computed tomography in diagnostics have a number of advantages and disadvantages, and the question of choosing a specific method still causes scientific controversy. We also provide illustrative clinical examples demonstrating echographic and computed tomographic imaging manifestations of acute appendicitis, as well as discuss visualization signs. For a patient with suspected acute appendicitis, in order to increase the accuracy of diagnosis, reduce complications or the need of undergoing unnecessary diagnostic and therapeutic procedures, a multidisciplinary and multimodal approach is necessary, taking into account age, gender and constitution, however, the question of choosing the optimal method of medical imaging in the diagnosis of acute appendicitis between ultrasound and computed tomography remains debatable.

Impact of COVID-19 on acute appendicitis presentation, management and pathology findings in adult and paediatric populations.

We investigated the impact of the COVID-19 pandemic on trends of presentation, management and pathology findings in patients who underwent an appendicectomy for suspected acute appendicitis. The retrospective study reviewed patients (n = 939 adults and n = 329 children) who had an appendicectomy performed for suspected acute appendicitis and histopathology assessment in the Belfast Health and Social Care Trust, Northern Ireland. Pre-COVID-19 (March 2019 to February 2020) and COVID-19 Year 1 (March 2020 to February 2021) data were compared. Chi-squared tests were applied to compare timeframes. 513 adult appendicectomies were performed in the immediate year pre-COVID-19, compared to 426 in COVID-19 Year 1, representing a 17% reduction. No such reduction was seen within the paediatric population, likely related to a change in regional paediatric referral criteria during the pandemic. When comparing COVID-19 Year 1 with pre-pandemic, fewer patients presented with <24 hours of symptoms (45% v 53%, p = 0.005), and there was greater use of pre-operative computed tomography imaging in adults (63.2% v 48.7%, p<0.001). Fewer adult and paediatric cases of simple acute appendicitis and non-diagnostic specimens, with relative increased proportions of perforated acute appendicitis, were observed in COVID-19 Year 1 compared with pre-pandemic. No absolute increase in perforated acute appendicitis cases was observed in adults. Year 1 of the COVID-19 pandemic was associated with delayed presentation of acute appendicitis in adults and children. In adults, an overall reduction in appendicectomy operations, increased use of pre-operative diagnostic imaging, and fewer specimens showing simple acute appendicitis or non-diagnostic features, collectively support appropriate restriction of surgery for those patients with a more certain acute appendicitis diagnosis.

Diagnostic Efficacy Study Comparing Tzanakis Scoring System With Alvarado Scoring System in Effective Diagnosis of Acute Appendicitis.

Objective Among the common causes of abdominal emergencies, acute appendicitis ranks at the top, particularly in the young population. While negative appendectomy is not uncommon, the risk of appendicular perforation is substantial if the diagnosis is missed or delayed. This study evaluated the diagnostic efficacy of the Tzanakis scoring system for acute appendicitis, comparing it with the Alvarado scoring system, considering the histopathological finding as the gold standard. Materials and methods This prospective observational study, conducted in the General Surgery department in a tertiary care hospital in India, included clinically diagnosed acute appendicitis cases posted for open or laparoscopic appendicectomy. Results The mean age for the 60 participants included in the study was30.97±13.44, and the median was 24.5 yrs. The sensitivity ofultrasonography (USG)in diagnosing histopathological positive acute appendicitis was 89%, and the specificity was 50%. The sensitivity, specificity, positive, and negative predictive values of the Tzanakis score were 87%, 50%, 96%, and 22%, respectively, and those of the Alvarado score were 54%, 75%, 96%, and 10%, respectively. Conclusion The receiver operator characteristic (ROC) curve for the Alvarado and Tzanakis scores showed that the area under the curve (AUC) was greater for the Tzanakis scoring system (0.670) than for the Alvarado scoring system (0.598). Differences between the AUCs were not statistically significant. Although the Tzanakis scoring system is more sensitive than the Alvarado scoring system in diagnosing acute appendicitis, studies with larger samples are needed to show the superiority of this scoring system over the Alvarado scoring system.

Appendicoscopy using single-operator cholangioscope in the management of acute obstructive appendicitis: a novel alternative (with video)

The aim of this study was to investigate the safety and efficacy of appendicoscopy using a single-operator cholangioscope (SOC) for the management of acute obstructive appendicitis. This study describes 110 cases of acute obstructive appendicitis managed with the use of appendicoscopy between January 2021 and June 2023. The success rate (technical+ clinical), procedure time, time to abdominal pain relief according to a visual analog scale score, postoperative length of hospital stay, and adverse event rates were recorded and analyzed. The technical success rate of appendicoscopy was 96.4%, and the clinical success rate was 91.8%. The mean ± standard deviation procedure time was 20.9 ± 10 minutes. The abdominal pain score at 6 hours after the procedure was≤3 (visual analog scale method) in 99.1% of patients. The average length of postoperative hospital stay was 3.5 ± 1.5 days. No adverse events occurred. Appendicoscopy seems to be a feasible and effective alternative therapy for the accurate diagnosis and treatment of acute obstructive appendicitis.

A Rare Case of Acute Appendicitis Associated with Endoscopic Mucosal Resection (EMR) of A Large Cecal Polyp

A Rare Case of Acute Appendicitis Associated with Endoscopic Mucosal Resection (EMR) of A Large Cecal Polyp

Misdiagnosis of Acute Appendicitis Cases in the Emergency Room.

Acute appendicitis (AA) is one of the most frequent surgical emergencies, especially in pediatric populations, with its misdiagnosis in emergency settings presenting significant health risks. This misdiagnosis leads to various complications, such as delayed treatment or unnecessary surgeries. Factors such as age, gender, and comorbidities contribute to diagnostic errors, leading to complications such as peritonitis and increased negative appendectomy rates. This underscores the importance of accurate clinical assessment and awareness of common pitfalls, such as cognitive biases and over-reliance on laboratory tests. This review delves into the prevalence of AA misdiagnosis, its health burden, and the challenges inherent in the diagnostic process. It scrutinizes the effectiveness of different diagnostic approaches, including clinical assessment and imaging techniques. The treatment paradigms for AA are also explored, focusing on surgical interventions and the potential of conservative treatments using antibiotics. The review underscores the criticality of precise diagnosis in preventing adverse outcomes and ensuring effective treatment.

Retrospective analysis of acute appendicitis in COVID-19 pandemic – A clinical study of 100 cases

Acute appendicitis is a very common abdominal emergency condition. The incidence varies from 5.7 to57 patient /lakh population per year in the world wide survey. It is frequent in both sexes, But highest in children &amp; adolescences. Presentation of this condition is some time so confusing that it should be distinguished from other acute abdominal conditions in proper time and appropriate measures should be taken to treat the patients to avoid unwanted complications, this complication is probably more complicated in COVID-19 pandemic period. This study is designed to compare acute appendicitis cases in relation to clinical features, gradation of disease &amp; post operative complications before COVID-19 (June 2019-March 2020) and during COVID-19 pandemic period (April 2020-October 2021). METHOD-Cases of the study were divided into 2-groups.Group-A (65 cases) in pre- pandemic period and Group-B (35 cases) in pandemic period. The study is based on the clinico-radiological features, laboratories investigations and gradation of disease. Gradation: Grade-I (probably appendicitis), Grade-II (definite appendicitis), Grade-III (perforation of appendices), Grade-IV (appendicular abscess), Grade-V (complicated appendicitis/ appendicular lump). Out of 100 enrolled cases 65 belongs to pre pandemic and 35 in pandemic period. It was found that increase in post-operative complications, were more in higher grade groups during pandemic periods. The COVID-19 pandemic has great impact on diagnosis, treatment and increased complications in post operative period of acute appendicitis, probably due to late presentation in emergency department. Pandemic directly or indirectly affect the outcome of a disease process and management.

The Effect of COVID-19 Pandemic on Acute Appendicitis Presentation

Background: Acute appendicitis is the most frequent emergency abdominal condition in general surgical practice. Appendectomy can be performed as open surgery or laparoscopically. Coronavirus disease 2019 (COVID-19), the highly contagious viral illness caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), differing in the diagnosis. Aim of the study: To analyze the impact of the COVID-19 pandemic on the time elapsed between onset of symptoms and diagnosis of Acute Appendicitis and the effect of this delay on disease progression. Methods: A prospective study was conducted in the Department of General Surgery at surgical ward in Baghdad Teaching Hospital during the period of one year from first of July 2020 till first of July 2021. A hundred patients were enrolled in this study. Results: This study included 100 patients complained from acute appendicitis, divided into two groups 52 of them were COVID-19 positive and 48 of them COVID-19 were negative patients. The mean time elapsed from onset of symptoms to surgical intervention was (73.44 hours) in COVID-19 positive patients versus mean (28.56 hours) in COVID-19 negative patients, and the results were statistically significant (p&lt;0.0001). Total patients who presented with complicated appendicitis were (36), 26 of them were COVID-19 positive, of them 8 patients presented with perforation. Conclusion: The increase in complicated cases of acute appendicitis seems to be associated with the delay from time of symptoms onset to surgical intervention.

A prospective study to evaluate the contribution of the pediatric appendicitis score in the decision process.

The objective of this study was to assess the likelihood of acute appendicitis (AA) in children presenting with abdominal symptoms at the emergency department (ED), based on their prior primary care (PC) consultation history. Between February and June 2021, we prospectively enrolled all children presenting at the ED with acute abdominal pain indicative of possible acute appendicitis (AA). Subsequently, they were categorized into three groups: those assessed by a PC physician (PG), those brought in by their family without a prior consultation (FG), and those admitted after a PC consultation without being assessed as such. The primary objective was to assess the probability of AA diagnosis using the Pediatric Appendicitis Score (PAS). Secondary objectives included analyzing PAS and C-reactive protein (CRP) levels based on the duration of pain and final diagnoses. 124 children were enrolled in the study (PG, n = 56; FG, n = 55; NG, n = 13). Among them, 29 patients (23.4%) were diagnosed with AA, with 13 cases (23.2%) from the PG and 14 cases (25.4%) from the FG. The mean PAS scores for AA cases from the PG and FG were 6.69 ± 1.75 and 7.57 ± 1.6, respectively, (p = 0.3340). Both PAS scores and CRP levels showed a significant correlation with AA severity. No cases of AA were observed with PAS scores < 4. There was no significant difference in PAS scores between patients addressed by PG and FG, even though PAS scores tended to be higher for patients with AA. We propose a new decision-making algorithm for PC practice, which incorporates inflammatory markers and pain duration. Institutional Ethics Committee registration number: 447-2021-103 (10/01/2021). ClinicalTrials.gov Identifier: NCT04885335 (Registered on 13/05/2021).

Impact of the COVID-19 Pandemic on the Incidence of Complicated Appendicitis in a Tertiary Medical Center, Amman, Jordan. A retrospective cohort.

Abstract&#x0D; Objective: To assess the incidence of complicated appendicitis during the COVID-19 pandemic in Jordan University Hospital.&#x0D; Materials and Methods: in this cohort study, we retrospectively investigated data on acute appendicitis cases, two groups were established, the first group was the pandemic group, which includes patients who presented to the hospital during the period of acute restrictions and shutdowns extending from the 17th of March to the 6th of June 2020, and the pre-pandemic group which represents the same period in the previous year. These two groups were compared in terms of clinical characteristics and the prevalence of complicated appendicitis.&#x0D; Results: A total of 45 patients were included in the study, 24 in the pandemic group and 21 in the pre-pandemic group. Gender distribution was not significant between the two periods (P-value&gt;0.05). Rates of occurrence of overall complications, preoperative complications, and intraoperative complications were similar indicating no significant difference between the two groups (P-value=0.526, 0.835, and 0.547, respectively). The duration between symptoms and admission and ALVARADO score were not significantly different between the two study groups. Also, the duration of in-hospital stay was numerically but not significantly lower in the 2019 (March-June) group compared to 2020 (March-June).&#x0D; Conclusion: In our study, there was no significant difference in the incidence of complicated appendicitis between pandemic and pre-pandemic groups.&#x0D;

Diagnostic Accuracy of Ileocolic Artery and Vein Diameter for Acute Appendicitis.

BACKGROUND Regional inflammation-induced local vasodilation may exist in cases of appendicitis. In this study, the diameters of the ileocolic artery (ICA) and ileocolic vein (ICV) were measured using contrast-enhanced abdominal computed tomography (CT) scans in acute appendicitis cases. The study aimed to measure the diagnostic value of these measurements in the diagnosis of acute appendicitis. MATERIAL AND METHODS A total of 508 patients, including those with a diagnosis of acute appendicitis and a control group without appendicitis, were systematically evaluated. In all cases, the appendix was analyzed simultaneously on axial and coronal CT sections, and all measurement procedures were conducted with an electronic ruler after the actual images were magnified. Measurements of the ICA and ICV diameters were taken from the proximal 2-cm segments of the superior mesenteric artery and superior mesenteric vein in the axial plane. Demographic information, sex distribution, and ICA and ICV diameters were collected. RESULTS Of the 508 patients, 53.74% were men, and 46.26% were women. ICA and ICV diameters were significantly increased in the appendicitis group (P<0.001). Binomial logistic regression confirmed the independent predictive value of ICA and ICV diameters. Receiver operating characteristic curve analysis determined optimal cut-off values for distinguishing between the non-appendicitis and appendicitis groups (ICA: 2.475 mm, ICV: 3.885 mm) with high sensitivity and specificity. CONCLUSIONS ICA and ICV diameter measurements, in conjunction with major radiological findings, can enhance diagnostic accuracy in acute appendicitis cases. The use of ICA and ICV diameter measurements in diagnosing acute appendicitis offers a novel perspective in clinical practice.

The impact of the COVID-19 pandemic on acute appendicitis patients in a tertiary care center in Lebanon

IntroductionWith it becoming a global pandemic, the coronavirus disease of 2019 (COVID-19) imposed public health restraints that hampered patient’s presentation to hospitals. In Lebanon, little is known about the presentation patterns of acute appendicitis (AA) patients among different population groups during the COVID-19. Therefore, this study aims to assess the effects of the COVID-19 pandemic on the rates of cases seen during the pandemic period, the adopted management strategies, and evaluate the patient outcomes compared to presentations from previous years.MethodsThis is a retrospective, observational cohort study with no interventional procedures. All patients presented to our tertiary health care center were diagnosed with AA between February 2019 and February 2021 comprised the study analysis. We divided our patients into the pre-pandemic period cohort March 1st, 2019, till February 29th, 2020, and the pandemic period cohort March 1st 2020 till March 1st 2021.ResultsWe collected data retrospectively from 342 patients: 201 patients presented in the pre-pandemic period and 141 during the pandemic period. Male predominance was seen in both cohorts (51.7% and 58.9% respectively). A decrease in the number of AA cases was seen during the pandemic, however, the duration of symptoms before presentation was similar in both cohorts (p = 0.382) Additionally, the number of complicated appendicitis cases was not different between cohorts. The main imaging modality was CT in both groups with no statistically significant difference in the type of imaging between them (p = 0.398). Further, the predominant treatment modality remained surgery during the pandemic, with no difference between both periods (p = 0.200), and no statistically significant difference in the type of surgery performed as laparoscopic surgery remained the most common surgery type in the pandemic period (p = 0.43). Finally, no extra surgical and post-surgical complications were identified.ConclusionIn conclusion, our study is an example of how the COVID-19 pandemic did not significantly affect patients presenting for AA. Despite the COVID-19-related restrictions, Lebanese patients with worrying symptoms were presenting to the emergency department and the American University of Beirut Medical Center was providing them with the standards of care. Our study mirrors the Lebanese experience and gives an example of a population that focused more on their current symptoms than the fear of acquiring the COVID-19 virus. Further research is needed to assess whether this was the correct approach during these times.

Evaluation of Acute Abdomen by Multidetector Computed Tomography: A Prospective Study in a Tertiary Care Hospital in Andhra Pradesh, India

Abstract Background and Objective: Evidence on the efficiency of multidetector computed tomography (MDCT) in diagnosing acute abdomen in the Indian setting is lacking. This study was conducted to estimate the incidence of various causes of acute abdomen, correlate MDCT observations with postoperative findings, and estimate the sensitivity and specificity of MDCT findings. Methods: In this prospective study, 54 patients with acute abdomen were recruited in the emergency department (ED) of a tertiary care hospital in Chittoor, India. In these patients, MDCT observations were compared with postoperative findings, and the sensitivity and specificity of MDCT findings were estimated. Results: The majority of the patients presented with pain in epigastrium (n = 13, 24.1%), and 46 (85.2%) had nontraumatic acute abdomen. Pancreatitis was the major cause of nontraumatic acute abdomen. MDCT had failed to detect one case of acute appendicitis, one calculous cholecystitis, Meckel’s diverticulum, stricture ureter, and degloving injury of the colon. Overall, MDCT was positive for 57 out of a total of 63 conditions (eight patients had two different diagnoses) and it could rule out acute abdomen accurately in one patient. The sensitivity of MDCT in diagnosing acute abdomen was 92% and specificity was 100%. Conclusion: MDCT is a valuable diagnostic radiological investigation for patients with acute abdomen presenting to the EDs. Its multiple advantages put it ahead of the other traditional radiological investigations.

One Case of Acute Appendicitis Caused by G1 Grade Neuroendocrine Tumor of the Appendix

One Case of Acute Appendicitis Caused by G1 Grade Neuroendocrine Tumor of the Appendix

Unraveling the Unusual Pathological Findings of Appendiceal Lesions: A Cross-sectional Study from Tertiary Care Centre in Chengalpattu, Tamil Nadu, India

Introduction: The appendix, once considered a vestigial structure, is now recognised as a site of diverse pathologies beyond simple appendicitis through a systematic analysis of published literature and case studies. The diagnosis of appendiceal lesions is still a clinical phenomenon and a constant struggle. The gold standard for diagnosing appendiceal lesions, however, is meticulous histopathological examination. Aim: To determine the histopathological distribution of all the appendiceal lesions and to identify the rare and unusual histopathological findings in appendectomy specimens received at a tertiary care Centre. Materials and Methods: A cross-sectional study was conducted in the Department of Pathology at Karpaga Vinayaga Institute of Medical Sciences and Research Centre, Chengalpattu, Tamil Nadu, India for a duration of 10 years, from August 2013 to August 2023. From the histopathological records of 832 appendectomies, 40 specimens with unusual histopathological findings were identified and analysed in this study. Relevant recorded data from all the appendiceal specimens reported during the study period, with special reference to age, sex, and histopathological findings, were retrieved and evaluated retrospectively. Corresponding slides and specimens were reviewed. The data were presented in the form of frequency tables and percentages. The analysis was done using Statistical Package for Social Sciences (SPSS) software version 20.0. Results: Out of 832 appendectomy specimens, there were 485 (58.29%) cases of acute appendicitis, 244 (29.33%) cases of chronic appendicitis, 59 (7.09%) cases of subacute appendicitis, and 4 (0.48%) cases of gangrenous appendicitis. Unusual histopathology findings were noted in 40 cases (4.81%). These include 17 cases of appendiceal neuroma, eight cases of Xanthogranulomatous appendicitis, seven cases of Enterobius vermicularis, three cases of Low-grade Appendiceal Mucinous Neoplasm (LAMN), one case of appendiceal Neuroendocrine Tumour (NET), one case of Goblet Cell Adenocarcinoma (GCA), one case of metastatic squamous cell carcinomatous deposit in the appendix, one case of urothelial rests in the appendix, and one case of appendiceal lipoma. Conclusion: In this study, 4.81% of patients had atypical appendiceal lesions. A complete histopathological examination of appendectomy specimens increases the chances of discovering unusual lesions of the appendix. Ultimately, this comprehensive analysis will contribute to future improvements in clinical management and prognostication, fostering better patient outcomes.

Effect of Ondansetron on Postoperative Pain and Vomiting after Acute Appendicitis Surgery: A Placebo-Controlled Double-Blinded Randomized Clinical Trial.

Common postoperative complications following surgery, particularly acute appendicitis surgery, include postoperative pain and vomiting, which can cause discomfort and delay recovery time. A randomized double-blinded placebo-controlled clinical trial was conducted with 80 cases of acute appendicitis of American Society of Anesthesiologists (ASA) physical status I or II and aged 18-60 y/o scheduled for appendectomy under general anesthesia. Patients were randomly divided into two equal groups: group A received 4 mg of ondansetron IV (2 ml) and group B received 2 ml of normal slain IV (placebo). Pain according to VAS, nausea and vomiting according to clinical symptoms, shivering and sedation according to the Bedside Shivering Assessment Scale (BSAS), and the Ramsay Sedation Scale (RSS) at 2, 6, 12, and 24 hours after surgery were evaluated and compared between the groups. There was a significant decline in the severity of pain only at 2 hours after surgery between the ondansetron and control groups (5.3 ± 1.0 vs. 6.0 ± 1.0; p=0.01), not showing a difference between the groups at 6, 12, and 24 hours after appendectomy. Postoperative nausea and vomiting at 2 (5% vs. 25%; p=0.03) and 6 (7.5% vs. 27.5%; p=0.04) hours after appendectomy in the ondansetron group. At different times, the ondansetron and control groups did not differ in terms of pethidine consumption or sedation. In conclusion, our study found that ondansetron was effective in reducing postoperative vomiting after acute appendicitis surgery. However, it did not show a clinically significant effect on postoperative pain. This trial is registered with IRCT20230722058883N1.

Establishment and validation of nomogram prediction model for complicated acute appendicitis

Objective: To establish and internally validate a nomogram model for predicting complicated acute appendicitis (CA). Methods: The clinical data from 663 acute appendicitis patients from the First Affiliated Hospital of Anhui University of Traditional Chinese Medicine from October 2015 to October 2022 were retrospectively analyzed. There were 411 males and 252 females, aged (M (IQR)) 41 (22) years (range: 18 to 84 years). There were 516 cases of CA and 147 cases of uncomplicated acute appendicitis. The minimum absolute contraction and selection operator regression model was used to screen the potential relative factors of CA, and the screened factors were included in the Logistic regression model for multivariate analysis. Software R was used to establish a preoperative CA nomogram prediction model, the receiver operating characteristic curve of the model was drawn, and the value of area under the curve (AUC) was compared to evaluate its identification ability, and the Bootstrap method was used for internal verification. Results: The elderly (age≥60 years) (OR=2.428, 95%CI: 1.295 to 4.549), abdominal pain time (every rise of 1 hour) (OR=1.089, 95%CI: 1.072 to 1.107), high fever (body temperature≥39 ℃) (OR=1.122, 95%CI: 1.078 to 1.168), total bilirubin (every rise of 1 μmol/L) (OR=2.629, 95%CI: 1.227 to 5.635) were independent relative factors of CA (all P<0.05). The AUC of this model was 0.935 (95%CI: 0.915 to 0.956). After internal verification using the Bootstrap method, the model still had a high discrimination ability (AUC=0.933), and the predicted CA curve was still in good agreement with the actual clinical CA curve. Conclusion: The clinical prediction model based on the elderly (age≥60 years), prolonged abdominal pain time, high fever (body temperature≥39 ℃), and increased total bilirubin can help clinicians effectively identify CA.