Common Abdominal Emergency Research Articles

Adult appendicitis score versus Alvarado score: A comparative study in the diagnosis of acute appendicitis

BackgroundAcute Appendicitis (AA) is the most common abdominal surgical emergency. It requires proper management to decrease mortality and morbidity. Clinical scoring systems for diagnosing AA aimed to decrease the use of radiological scans and the rate of negative appendectomies (NA). We aim to assess the adult appendicitis score (AAS) in the diagnosis prediction of AA. MethodA retrospective study with 1303 cases of AA is performed. We compared the correlation of AAS and Alvarado scores to postoperative histopathology. Specificity, sensitivity, Positive Predictive Value (PPV), and Negative Predictive Value (NPV) were assessed. ROC was used. ResultsAAS risk stratification was applied to the study population. Group I for a low probability, and groups II and III for an intermediate and high probability of AA. We found that 159 patients were matched in group I, 505, and 639 were in groups II and III of AAS, respectively. The correlation between Alvarado and AAS with HP was significant. AAS ≥ 16 presented sensitivity and specificity of 50 % and 75.47 %, respectively, with PPV of 97.96 % and NPV of 6.02 %, with an accuracy of 51.04 %. Regarding AAS ≥ 11, the sensitivity was 88.96 %, specificity was 39.62 %, PPV was 97.2 %, NPV was 13.21 %, and accuracy was 86.95 %. ConclusionAAS is relatively more accurate than Alvarado's score, especially in selecting a safe candidate for discharge from an emergency. In addition, AAS is found to decrease the need for radiological images and NA rate more than Alvarado.

Treatment outcome of appendicitis in Azare

Objectives: Appendicitis is and has remained one of the most common abdominal surgical emergencies the world over. Its procedure and appendectomy is also a very common and regularly done surgical procedure and, thus, a very important disease to describe in totality. Hence, we set out to describe the pattern of presentation and management outcome of this condition in our environment. Materials and Methods: Data were collected retrospectively of all patients with the clinical diagnosis of appendicitis during the study period and analyzed. Results: A total of 62 patients had a clinical diagnosis of appendicitis over the period under review. M: F was 1:1.1. Age ranged from 3 years to 47 years with a mean of 21.50 ± 10.07. All (100%) patients presented with right iliac fossa pain. Other symptoms were anorexia (45.2%), nausea (61.3%), and vomiting (40.3%). All (100%) of patients went on to have an appendectomy. Twelve (19.40%) patients had surgical site infection and 2 (3.20%) developed enterocutaneous fistula. Duration of hospital stay ranged from 1 to 30 days. One patient who had uncontrolled diabetes mellitus died giving a mortality rate of 1.6. Conclusion: Typical clinical features of acute appendicitis were lower abdominal quadrant pain associated with nausea, anorexia, and vomiting. It goes without saying that diagnosis can still be made comfortably on clinical grounds and treatment outcome is generally good.

Role of C reactive protein, hyperbilirubinemia and mean platelet volume in diagnosis of acute appendicitis and its correlation post operatively with histo-pathological examination

Background: Acute appendicitis is one of the most common abdominal emergencies requiring emergency surgery. The diagnosis based on the onset of symptoms and physical examination. Therefore, inaccuracies caused by subjective interpretation are frequent. This raises the need for tests to help diagnose acute appendicitis and predict the severity of the condition. aim of the study to investigate whether mean platelet volume, C-reactive protein, and hyperbilirubinemia can be used as inflammatory markers for the diagnosis of acute appendicitis and its correlation with histopathological examination. Methods: we prospectively analyzed 60 patients who were full fulling the inclusion criteria patients analysed for CBC, LFT and CRP and underwent for appendicectomy (Laparoscopic/open). Per-operative diagnosis was confirmed by histopathological examination from November 2020 to November 2022. Results: patients with CRP level > 6 and hyperbilirubinemia patients most likely to have acute appendicitis. Mean CRP level was 13.21±4.0 and mean bilirubin level 1.04±0.29 in case of acute appendicitis. CRP, hyperbilirubinemia levels were significantly higher in cases of acute appendicitis (p<0.01) while MPV value was not found significant. All patients was confirmed with histopathology examination. Conclusions: Serum bilirubin level and CRP estimation, which is a simple, cheap, and easily available laboratory test, can be added to the routine investigations in the diagnosis and severity of acute appendicitis and help in decreasing negative appendicectomy rates, especially in low modified Alvarado score.

Routine Pediatric Surgical Emergencies: Incidence, Morbidity, and Mortality During the 1st 8000 Days of Life—A Narrative Review

BackgroundMany potentially treatable non-congenital and non-traumatic surgical conditions can occur during the first 8000 days of life and an estimated 85% of children in low- and middle-income countries (LMICs) will develop one before 15 years old. This review summarizes the common routine surgical emergencies in children from LMICs and their effects on morbidity and mortality.MethodsA narrative review was undertaken to assess the epidemiology, treatment, and outcomes of common surgical emergencies that present within the first 8000 days (or 21.9 years) of life in LMICs. Available data on pediatric surgical emergency care in LMICs were aggregated.ResultsOutside of trauma, acute appendicitis, ileal perforation secondary to typhoid fever, and intestinal obstruction from intussusception and hernias continue to be the most common abdominal emergencies among children in LMICs. Musculoskeletal infections also contribute significantly to the surgical burden in children. These “neglected” conditions disproportionally affect children in LMICs and are due to delays in seeking care leading to late presentation and preventable complications. Pediatric surgical emergencies also necessitate heavy resource utilization in LMICs, where healthcare systems are already under strain.ConclusionsDelays in care and resource limitations in LMIC healthcare systems are key contributors to the complicated and emergent presentation of pediatric surgical disease. Timely access to surgery can not only prevent long-term impairments but also preserve the impact of public health interventions and decrease costs in the overall healthcare system.

Trends in the mortality, incidence and disability-adjusted life-years of appendicitis in EU15+ countries: an observational study of the global burden of disease database, 1990-2019.

Appendicitis places a substantial burden on healthcare systems, with acute appendicitis alone being the most common abdominal surgical emergency worldwide. Further characterisation of the disease burden in EU15+ countries may help optimise the distribution of healthcare resources. The aim of this observational study was to assess the trends in mortality, incidence and DALYs of appendicitis across European Union (EU) 15+ countries between the years 1990 and 2019, Supplemental Digital Content 3, http://links.lww.com/JS9/A589. Age standardised mortality rates (ASMRs), age standardised incidence rates (ASIRs) and disability adjusted life years (DALYs) data for appendicitis in males and females were extracted from the 2019 Global Burden of Disease (GBD) study. Temporal trends within the study period were analysed using Joinpoint regression analysis. The median ASMRs across EU15+ countries in 2019 were 0.08/100,000 and 0.13/100,000 for females and males, respectively. Between 1990 and 2019 the median percentage change in ASMR was -52.12% for females and -53.18% in males. The median ASIRs in 2019 for females and males were 251/100,000 and 278/100,000, respectively, with a median percentage change of +7.22% for females and +3.78% for males during the observation period. Decreasing trends in DALYs were observed over the 30-year study period, with median percentage changes of -23.57% and -33.81% for females and males, respectively, Supplemental Digital Content 3, http://links.lww.com/JS9/A589. Overall, a general trend of decreasing appendicitis ASMRs and DALYs was observed across EU15+ countries, despite small overall increases in appendicitis ASIRs, Supplemental Digital Content 3, http://links.lww.com/JS9/A589. Variations in both diagnostic and management strategies over the study period are likely contributory to the changing trends.

Abdominal Emergencies in Cancer Patients.

Abdominal emergencies in cancer patients encompass a wide spectrum of oncologic conditions caused directly by malignancies, paraneoplastic syndromes, reactions to the chemotherapy or often represent the first clinical manifestation of an unknown malignancy. Not rarely, clinical symptoms are the tip of an iceberg. In this scenario, the radiologist is asked to exclude the cause responsible for the patient's symptoms, to suggest the best way to manage and to rule out the underlying malignancy. In this article, we discuss some of the most common abdominal oncological emergencies that may be encountered in an emergency department.

Operative and Non-Operative Hemoperitoneum in Blunt Abdominal Trauma, General Surgery Department, Sikasso Hospital

Blunt abdominal trauma being one of the most common abdominal emergencies; they explain the patient's indication of armed expectation in the absence of any notion of hemodynamic instability. The objectives were to determine the hospital frequency, to identify the etiologies and to analyze the therapeutic modalities. The study was retrospective and prospective from January 1, 2010 to December 31, 2018 involving 45 patients treated for hemoperitoneum in the general surgery department of Sikasso hospital. All patients admitted to the department for blunt abdominal trauma with hemoperitoneum were included. We collected 45 patients whose mean age was 18.7 years (extreme 3 - 55 years). The sex ratio was 4.6 in favor of men (37 M, 8 F). We found 23 (51.12%) cases of AVP, 13 (28.89%) cases of falls from a height, 11 (7.7%) cases of aggression, hoof kick 1 (2.22%). 19 (42.22%) patients had low haemoperitoneum, 16 (35.56%) medium abundance, 10 (22.22%) high abundance. 32 (71.11%) provided non-operative treatment with a mean hospital stay of 13.7 days (range 5 to 20). 1 patient was unstable, it was activated 24 hours later. We immediately had 12 patients (26.67%) with an average hospital stay of 16.5 days (extreme 10 -24) and the postoperative course was simple in 66.67% (8 cases). We recorded 1 death (2.22%).

O055 Robotic appendicectomy: a systematic review of feasibility

Abstract Introduction Acute appendicitis is known to be one of the most common abdominal surgical emergencies. Laparoscopic appendicectomy is considered the gold-standard management. There has been an increasing trend in the routine use of robotic surgery in abdominal surgery. However, it remains underutilised in emergency surgeries. We aimed to systematically review robotic appendicectomy (RA) procedures in elective and emergency settings and study its indications and feasibility. Methods A 20-year systematic review was performed in compliance with the PRISMA guidelines. The search was performed on PubMed, ScienceDirect and the Cochrane-Library databases. For quality assessment, Amstar 2 and MERSQI score were applied. The research protocol was registered with PROSPERO register for systematic reviews (CRD42022324582). Results A total of 1346 resulted from the systematic search, of which a final 9 articles were included in this study. A total of 174 procedures were included, 161 elective, 12 emergency and one interval RA. MERSQI mean score was 10.72 (SD= 2.56), with 4 high quality, 2 moderate and 3 low quality studies. The endpoints across the studies were: rate of conversion to open surgery, length of hospital stay, intra-operative blood loss and operative time. Conclusions Robotic appendicectomy is considered a safe and feasible technique with minimal blood loss and without conversion. The operating time and the hospital stay were within acceptable limits. Future studies are recommended to further evaluate RA with a focus on its application during emergency settings and on its cost-effectiveness.

Analysis of Appendicitis Cases in the Japanese Adverse Drug Event Report (JADER) Database.

Appendicitis is one of the most common abdominal surgical emergencies worldwide; however, its causes remain poorly understood. The Japanese Adverse Drug Event Report (JADER) database is a spontaneous reporting system (SRS) that can be utilized to analyze the safety signals of adverse events. In this study, we investigated the association between drug use and the onset of appendicitis using the JADER database. We first used the reporting odds ratio (ROR) as the signal and found signals for appendicitis, perforated appendicitis, and complicated appendicitis for 23, 9, and 1 drug, respectively. To investigate the level of hazard over time in drug-associated appendicitis, the Weibull shape parameter β was calculated using a Weibull plot, which revealed drug-dependent patterns for changes in the risk of appendicitis over time for the eight drugs. Furthermore, logistic regression analysis was performed to account for the influence of age, sex, and primary disease, and a significant association was detected between two drugs and appendicitis. Several types of drugs, such as antitumor, antirheumatic, and anti-inflammatory drugs, were included in our analyses; however, only clozapine, which is used for patients with schizophrenia, was commonly identified in these analyses. The resulting data suggest that certain drugs may be associated with appendicitis and may require adequate attention.

An observational study on lifestyle and environmental risk factors in patients with acute appendicitis

PurposeAcute appendicitis is a common abdominal emergency worldwide. This study aimed at characterizing environmental risk factors influencing the development and severity of acute appendicitis. MethodsPatients from a Belgian acute appendicitis cohort (n = 374) and healthy controls from the 500 functional genomics (500FG) cohort (n = 513) were compared. Individuals with a history of appendectomy (n = 1067) and without a history of appendectomy (n = 8656) were available from the Nijmegen Biomedical Study (NBS). Questionnaires on demographics, lifestyle and environment were available. Binary logistic regression was used for prediction models. ResultsFifteen risk factors for developing acute appendicitis were identified. Binary logistic regression showed that 7 were independent risk factors: family history of acute appendicitis, having grown up in a rural environment, having a lower education, probiotic use as well as antibiotic use increased the risk of developing appendicitis. Fruit and fiber-rich vegetable consumption decreased the risk. Findings on vegetable consumption, smoking and level of education were replicated in the NBS population. Independent risk factors for complicated appendicitis were being male, higher age, and a delay to diagnosis of more than 48 h. ConclusionsEnvironmental exposures influence the risk of developing appendicitis. Further research into these factors is needed.

Spectrum, Management, and Outcomes of Abdominal Surgical Emergencies at a Referral Hospital in North West Cameroon

Purpose: Abdominal surgical emergencies are a major health burden in low- and middle-income countries where management is often very challenging, and associated with high morbidity and mortality. The spectrum, management, and outcomes of abdominal surgical emergencies needs to be updated.Methods: This was a hospital-based retrospective cross-sectional study carried out in Bamenda, Cameroon over a 2-year period. Records of patients who met the inclusion criteria were reviewed, with pre-, intra- and postoperative data collected and analyzed.Results: There were 207 patients included in this retrospective review (male to female ratio of 1.4:1. The mean age was 47.4 (± 19.4) years. Intestinal obstruction (34.8%) and perforated peptic ulcers (15.5%) were the most common abdominal surgical emergencies. The median delay and interquartile range to presentation and in-hospital delay were 6 (4) days and 8 (12) hours, respectively. The mean length of hospital stay post-surgery was 11days. There were 48.3% of patients who developed a complication; 34.78% were major, 17.9% had an unplanned reoperation, and 15 (7.2%) were readmitted after discharge. The 30-day in hospital mortality was 19.8%. Mortality was independently associated with a high American Society of Anesthesiologists (ASA) score; ASA score > 3, age > 60 years, and referral from other health facilities.Conclusion: Intestinal obstructions from intraperitoneal neoplasm is the most common cause of abdominal surgical emergency in North West Cameroon. Abdominal emergencies here are associated with a very high morbidity and mortality in males > 60 years with an ASA score > 3 and with more than one comorbidity.

The global, regional, and national burden of appendicitis in 204 countries and territories, 1990–2019: a systematic analysis from the Global Burden of Disease Study 2019

BackgroundAppendicitis is the most common abdominal surgical emergency worldwide, and its burden has been changing. We report the level and trends of appendicitis prevalence, and incidence; and years lived with disability (YLD) in 204 countries and territories from 1990 to 2019, based on data from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019.MethodsThe numbers and age-standardized prevalence, incidence, and YLD rates per 100,000 population of appendicitis were estimated across regions and countries by age, sex, and sociodemographic index (SDI). All the estimates were reported with 95% uncertainty intervals (UIs).ResultsGlobally, the age-standardized prevalence and incidence rates of appendicitis in 2019 were 8.7 (95% UI 6.9 to 11.0) and 229.9 (95% UI 180.9 to 291.0) per 100,000 population, with increases of 20.8% (95% UI 18.9 to 23.0%) and 20.5% (95% UI 18.7 to 22.8%) from 1990 to 2019, respectively. Additionally, the age-standardized YLDs rate was 2.7 (95% UI 1.8 to 3.9) in 2019, with an increase of 20.4% (95% UI 16.2 to 25.1%) from 1990 to 2019. In 2019, the age-standardized prevalence, incidence, and YLD rates peaked in the 15-to-19-year age groups in both male and female individuals. However, no statistically significant differences were observed between the male and female individuals in all groups. Ethiopia, India, and Nigeria showed the largest increases in the age-standardized prevalence rate between 1990 and 2019. Generally, positive associations were found between the age-standardized YLD rates and SDI at the regional and national levels.ConclusionsAppendicitis remains a major public health challenge globally. Increasing awareness of appendicitis and its risk factors and the importance of early diagnosis and treatment is warranted to reduce its the burden.

The Course and Surgical Treatment of Acute Appendicitis during the First and Second Wave of the COVID-19 Pandemic: A Retrospective Analysis in University Affiliated Hospital in Latvia

Background and Objectives: Acute appendicitis is the most common abdominal emergency requiring surgery and it has an estimated lifetime risk of 6.7 to 8.6%. The COVID-19 pandemic has transformed medical care worldwide, influencing diagnostic tactics, treatment modalities and outcomes. Our study aims to compare and analyze management of acute appendicitis before and during the first and second waves of the pandemic. Materials and Methods: Patients suffering acute appendicitis were enrolled retrospectively in a single-center study for a 10-month period before the pandemic (pre-COVID-19 period: 1 March to 31 December 2019) and during the pandemic (COVID-19 period: 1 March to 31 December 2020). The total number of patients, disease severity, diagnostic methods, complications, length of hospitalization and outcomes were analyzed. Results: A total number of 863 patients were included, 454 patients in the pre-COVID-19 period and 409 patients in the COVID-19 period. Compared to the pre-COVID-19 period, the number of complicated appendicitis increased in the COVID-19 period (24.4% to 37.2%; p < 0.001). The proportion of laparoscopic appendectomies increased during the COVID-19 period but did not show statistically significant differences between periods. In both time periods, we found that open technique was the chosen surgical approach more frequently in elderly patients (p < 0.001). Generalized peritonitis was significantly more common during the COVID-19 period (3.5% vs. 6.1%, p < 0.001). The postoperative course of patients was similar in the pre-COVID-19 period and during the COVID-19 period, with no significant differences in ICU admissions, overall hospital stay or morbidity. Conclusions: The COVID-19 pandemic has led to a significant increase in complicated forms of acute appendicitis; however, no significant impact was observed in terms of diagnostic or treatment approach.

Abdominal Surgical Emergencies in Neonates

Abdominal surgical emergencies are relatively common in neonates. Some of them are related to congenital diseases such as intestinal atresia and intestinal malrotation, whereas some are entirely postnatal conditions such as necrotizing enterocolitis and gastric perforation. While there is a wide range of clinical severity for these conditions, outcomes are most favorable with prompt identification and expeditious treatment. In this review, we describe the most common neonatal abdominal surgical emergencies, highlight the signs that can help with early detection, and explain the approach to diagnosis and management.

The Role of Alvarado Score in Diagnosis of Acute Appendicitis in a Tertiary Care Hospital

Background: Acute appendicitis is one of the most common abdominal emergencies encountered in surgical practice. The diagnosis of acute appendicitis is an enigmatic challenge. Several studies have reported a variable diagnostic accuracy with a negative appendectomy rate varying from 3% up to 20% using combined diagnostic modalities or using the Alvarado score alone.

Surgically proven small bowel intussusception in children: Analysis of 36 cases

Background: Intussusception is one of the most common abdominal emergencies in children. While the majority of childhood intussusceptions are ilecolic and idiopathic, small bowel intussusceptions are rare and a pathological trigger is often blamed for the etiology. Ultrasonography is the most commonly used diagnostic tool in the diagnosis of intussusception.&#x0D; Objectives: To determine auxiliary diagnostic criteria for ultrasonography in the differentiation of small bowel intussusceptions based on ultrasonography, reduction and surgical findings of surgically confirmed small bowel intussusceptions and to contribute to the diagnosis and treatment algorithm of small bowel intussusceptions based on our clinical experience.&#x0D; Methods: The records of patients who underwent surgery for small bowel intussusception at the Faculty of Medicine, Department of Pediatric Surgery between January 2008 and December 2020 were retrospectively reviewed. Demographic characteristics, ultrasonographic findings, onset and duration of symptoms, treatment method, intraoperative findings and histopathological results of the patients were recorded.&#x0D; Results: Thirty-six pediatric patients with small bowel intussusception were operated. The average age of these patients was 59 ± 49.7 months and %78 was male. The location of the small bowel intussusception detected by ultrasound scan was the paraumbilical area and left quadrant in 19 (53%) patients and the right quadrant in 15 (42%) patients. In ultrasonography, the mean diameter of the invaginated segment was 3 (1.2-6.5) cm and the mean length was 6.7 (3-15) cm. Pathological lead points were detected in the etiology of nineteen (53%) patients. Thirteen (36%) patients underwent segmental resection and anastomosis due to necrosis.&#x0D; Conclusions: Small bowel intussusceptions are often localized in the paraumbilical and left upper quadrant. However, it should be kept in mind that it may be localized in the right lower quadrant like ileocolic invaginations. Enema reduction can be used as an adjunctive diagnostic method to exclude ileocolic invaginations rather than treatment in these patients. The diameter and length of the invaginated segment may be decisive in the surgical decision of the small bowel intussusception.

Ultrasonic diagnosis of acute appendicitis

Background: Acute appendicitis is the most common surgical abdominal emergency. The diagnosis is suspected and performed primarily on the basis of clinical findings. Sometimes presentation is so difficult that even the most experienced surgeon may miss the diagnosis. Lack of early diagnosis results in perforation and its complications. Although ultrasound is frequently used to diagnose acute appendicitis, the accuracy of this imaging test remains unclear because of a great variability in the reported performance. Aim of the study: to evaluate the benefit of ultrasonic in diagnosis for acute appendicitis patients and methods: Between Jan. 2014 and Jan. 2015, we collected 91 patients (male 56, 61.54%, female 35, 38.46%) their ages range from 7 to 50 years with clinical diagnosis of acute appendicitis they were sent to ultrasonic studying in radiological department to confirm diagnosis of acute appendicitis. Results: Ultrasonic study was performed for a total 91 patients, in 59 patients was positive (64.84%), 39 was male &amp; 20 was female, 32 patients was negative (35.16%), 17 patients were males &amp; 15 patients were females (ultrasonic diagnosis of appendicitis). Sensitivity was 76.39%, specificity was 78.95%. Accuracy rate was 76.92%, the positive predictive value was 93.22% &amp; negative predictive value was 46.87%.Conclusion: Ultrasonic imaging can be performed before surgery for suspected acute appendicitis. Ultrasonic study is non-invasive, cheep, technical can repeated without harm to the patient and available even at bed, especially when surgeon is well-trained to do it.

EVALUATION OF SERUM C REACTIVE PROTEIN IN ACUTE APPENDICITIS AND ITS CORRELATION WITH HISTOPATHOLOGY

Background: Acute appendicitis is the most common abdominal surgical emergency, but its diagnosis remains an enigmatic challenge, plagued by a high rate of negative explorations. There is no single reliable test with satisfactory sensitivity and specicity. Ultrasonography is not often available at a rural surgical setup. This study is intended to evaluate the importance Aim: of serum C-reactive protein (CRP) level estimation in diagnosis of acute appendicitis, by comparing with histopathology report. In a Methods: prospective study,100 patients clinically diagnosed as acute appendicitis were selected by purposive sampling method and evaluated as per criteria for serum CRP levels, leucocyte count preoperatively and were followed up postoperatively with histopathology reports. The data was analysed for nding the signicance of serum CRP in the diagnosis of acute appendicitis. CRP was positive in 75 of the 77 patients who Results: had histologically proven acute appendicitis and in 3 with normal appendix. The sensitivity, specicity and diagnostic accuracy were 97.4%, 86.96% and 95% respectively. Leucocytosis and neutrophilia when used alone were not specic for acute appendicitis, but when combined with CRP value, diagnostic accuracy was high. Ultrasonography was useful in establishing alternative diagnoses, but had low sensitivity for acute appendicitis. CRP contains important diagnostic information and hence should always Interpretation &amp; Conclusion: be included in the diagnostic workup of acute appendicitis. Since acute appendicitis is very unlikely in those patients with normal WBC count and CRP value, conservative treatment is advised.This study does not undercut the skill of an experienced surgeon in diagnosing acute appendicitis, but CRP estimation compliments clinical diagnosis.

IL-5 Serum and Appendicular Lavage Fluid Concentrations Correlate with Eosinophilic Infiltration in the Appendicular Wall Supporting a Role for a Hypersensitivity Type I Reaction in Acute Appendicitis.

Appendicitis is the most common abdominal surgical emergency, but its aetiology is not fully understood. We and others have proposed that allergic responses play significant roles in its pathophysiology. Eosinophils and Interleukin (IL)-5 are involved in a hypersensitivity type I reaction. Eosinophil infiltration is common in the allergic target organ and is dependent on IL-5. In the presence of an allergic component, it is expected that the eosinophil count and IL-5 local and systemic concentrations become elevated. To address this hypothesis, we designed a prospective study that included 65 patients with acute appendicitis (grouped as acute phlegmonous or gangrenous according to the histological definition) and 18 patients with the clinical diagnosis of acute appendicitis, but with normal histological findings (control group) were enrolled. Eosinophil blood counts and appendicular wall eosinophil infiltration were determined. IL-5 levels in blood and appendicular lavage fluid were evaluated. Appendicular lavage fluid was collected by a new methodology developed and standardized by our group. Appendicular wall eosinophil infiltration was higher in acute phlegmonous appendicitis than in gangrenous appendicitis (p = 0.000). IL-5 blood levels were similar in both pathologic and control groups (p > 0.05). In the appendicular lavage fluid, the higher levels of IL-5 were observed in the phlegmonous appendicitis group (p = 0.056). We found a positive correlation between the appendicular wall eosinophilic infiltration and the IL-5 concentrations, in both the blood and the appendicular lavage fluid, supporting the IL-5 reliance in eosinophil local infiltration. We observed the highest presence of eosinophils at phlegmonous appendicitis walls. In conclusion, the present data are compatible with a hypersensitivity type I allergic reaction in the target organ, the appendix, during the phlegmonous phase of appendicitis.

The Use of Inflammatory Markers to Rule Out Acute Appendicitis in Pediatrics.

Background Acute appendicitis is the most common abdominal surgical emergency in pediatric patients. The diagnosis of acute appendicitis in pediatrics is challenging and requires an accurate physical examination, laboratory study, and imaging. The aim of this study was to determine the benefits of using three inflammatory markers, white blood count (WBC), neutrophils percent (NE%), and C-reactive protein (CRP), in ruling out appendicitis in pediatric patients. Methods A retrospective study was conducted of 152 pediatric patients aged between 6 months and 14 years presenting to the emergency department between January2018 and December2020, with the diagnosis of appendicitis as the primary physician's main diagnosis. Demographic information and clinical data were extracted from the medical file for each patient. Results Out of the 152 patients included, 68 (44.7%) were female and 84 (55.3%) were male, with median age was 8.1 years. Thirty-six (23.7%) had acute appendicitis confirmed by histopathology. Of these 36 patients, only two patients (5.6%) had all inflammatory markers within normal limits. Conclusion Although raised inflammatory markers may help diagnose acute appendicitis, their role in ruling it out remains limited.