Complicated Acute Appendicitis Research Articles

Case Report On Rare Co-Occurrence of Complicated Acute Appendicitis and Ovarian Cyst Rupture

Acute appendicitis is the most common surgical emergency, and is also the most common cause of non-gynecological pelvic pain. Female patients presenting with abdominal pain in the presence of an underlying gynecological pathology such as ectopic pregnancy, threatened abortion, ovarian cyst, tubo-ovarian abscess or pelvic inflammatory disease can mimic acute appendicitis, potentially complicate the clinical picture and affect the diagnostic accuracy. Open or laparoscopic surgery is the mainstay of management for Complicated Appendicitis. Our patient was operated having signs and symptoms of pelvic peritonitis, with intraoperative finding of pelvic cavity blood with right ruptured ovarian simple cyst. She also had significant appendiceal abscess contained by omentum, terminal ilium, cecum and sigmoid colon with eaten up appendix in the abscess. This is a rare co-occurrence of appendiceal abscess with ruptured ovarian cyst, only one previous published case report of acute appendicitis with ruptured ovarian cyst.

Diagnostic performance of serum CA-125 for overall and complicated acute appendicitis: a systematic review and meta-analysis.

This study aimed to analyze the diagnostic performance of serum CA-125 in acute appendicitis (AA). This review was registered in PROSPERO (CRD42023450988). We included prospective and retrospective original clinical studies evaluating the diagnostic performance of serum CA-125 in AA. A search was conducted in PubMed, Web of Science, Scopus, and OVID. Search terms and keywords were: (appendicitis OR appendectomy) AND (CA-125 OR CA125). Two independent reviewers selected the articles and extracted relevant data. Methodological quality was assessed using the QUADAS-2 index. A synthesis of the results, standardization of the metrics, and three random-effect meta-analyses were performed. Five studies with data from 533 participants (including 219 patients with a confirmed diagnosis of AA and 107 controls) were included in this review. The random-effect meta-analysis of serum CA-125 (AA vs controls) included 3 articles (125 AA and 70 controls) and resulted in a non-significant mean difference [95% CI] of -6.80 [-20.51, 6.92] U/mL (p = 0.33). The meta-analysis by subgroups that included only male patients resulted in a significant mean difference [95% CI] of 3.48 [0.46, 6.49] U/mL (p = 0.02). Although serum CA-125 does not appear to be a good overall marker for the diagnosis of AA, our subgroup analyses show that this marker could be useful for diagnosing AA in males. It also appears to be a potentially useful tool for discriminating complicated and uncomplicated AA. However, the limited number of included studies precludes drawing generalizable conclusions. Future prospective studies focused on males and in its potential ability to discriminate between complicated and uncomplicatedAAare required.Registration. PROSPERO (CRD42023450988).

Laparoscopic Appendectomy in the Treatment of Patients with Complicated Acute Appendicitis

Relevance Treatment of complicated forms of acute destructive appendicitis continues to be an urgent problem in emergency abdominal surgery. Aim of study Improving the results of surgical treatment of patients with appendiceal peritonitis with laparoscopic appendectomy.Material and methods A retrospective analysis of the treatment of 150 patients with acute appendicitis complicated by local and diffuse peritonitis aged from 17 to 69 years was carried out. There were 77 (51.3%) women and 73 (48.7%) men. Depending on the treatment tactics used, two groups of patients were divided. In the main group (64 patients), the leading treatment method was laparoscopic appendectomy. In the comparison group (86 patients), traditional approaches were used, including open appendectomy with the McBurney approach in 72 patients (83.7%) and laparotomy for diffuse peritonitis in 14 (16.4%).Results The analysis of the surgical techniques used showed that in the main group, wound postoperative complications developed in 9 patients (14.1%). In the comparison group, postoperative complications developed in 32 patients (37.2%). For local non­limited peritonitis, the total duration of hospitalization after laparoscopic appendectomy performed in 49 patients was 6.7±1.4 days, and 8.6±2.1 days (p<0.05) in 72 patients who underwent open appendectomy. The duration of hospitalization was 8.2±2.7 days in case of diffuse peritonitis after laparoscopic appendectomy, sanitation and drainage of the abdominal cavity (15 cases), and 12.4±1.3 days (p<0.05) in 14 patients after laparotomy, appendectomy, sanitation and drainage of the abdominal cavity, intubation of the small intestine.Conclusion Laparoscopic appendectomy may be the operation of choice for complicated forms of acute appendicitis according to developed indications. It should be performed by a surgeon experienced in endosurgical operations. To increase the efficiency of washing the abdominal cavity in case of diffuse peritonitis, it is recommended to use hardware sanitation. The capabilities of laparoscopic appendectomy make it possible to adequately perform the required amount of surgical treatment, minimize surgical trauma, and significantly reduce the rate of postoperative complications and the duration of hospital treatment compared to open appendectomy.

The role of C-reactive protein/albumin ratio and prognostic nutritional index in the diagnosis of complicated acute appendicitis

Objective: C-reactive protein (CRP) levels increase and albumin levels decrease in patients with inflammation. CRP/albumin ratio (CAR) is a new inflammation-associated prognostic indicator. The prognostic nutritional index (PNI) was described as a simple and neutral indicator of adverse outcomes not only in chronic diseases but also in acute conditions. The aim of this study was to investigate the clinical significance of the CAR and PNI value in differentiating complicated acute appendicitis (AA). Material and Methods: We retrospectively examined the medical records of 187 patients with AA. Patients were divided into two groups according to pathological results [non-complicated (n= 161) and complicated (n= 26)]. Demographic, clinical, laboratory, and pathological data were examined and compared between the groups. Logistic regression analyses were performed to determine the independent predictors for complicated AA. Results: Median age of the study group was 32 (23-41) years, and most of the patients were males (n= 101, 54%). Patients in the complicated AA group were significantly older compared to the patients in the non-complicated AA group [38 (32-49.5) years vs. 30 (22-41) years, p= 0.002]. The complicated AA group had significantly higher CAR level compared to the non-complicated AA group (p= 0.001). The length of hospital stay was significantly longer in the complicated AA group compared to the non-complicated AA group [2.5 (2-4.25) days vs. 1 (1-2) days, p< 0.001]. Other variables (including PNI) did not significantly differ between the groups. In univariate logistic regression analysis, only age was found to be a significant variable (OR= 1.045, 95% CI= 1.016-10.74, p= 0.002), but in multiple variate logistic regression analysis, no variable was found to be significant in predicting complicated AA. Conclusion: We concluded that CAR and PNI value are not independent predictors of complicated AA.

Predictors of complicated acute appendicitis: single-center analysis of a prospective cohort of 2500 adult patients

Predictors of complicated acute appendicitis: single-center analysis of a prospective cohort of 2500 adult patients

Usefulness of extended inflammatory parameters related to neutrophil activation reported by Sysmex XN-1000 hematology analyzer for predicting complicated acute appendicitis. Comparison with canonical inflammatory laboratory tests

AimAccurate diagnosis of complicated appendicitis is of importance to ensure that patients receive early and effective treatment, minimizing the risk of postoperative complications to promote successful recovery. Biochemical markers are a promising tool to identify complicated appendicitis. We aimed to evaluate the potential role of novel parameters related with neutrophil activation, known as “Extended Inflammation Parameters” (EIP), included in blood cell count reported by Sysmex XN-Series analyzers, compared to other canonical biomarkers in identifying complicated appendicitis. MethodProspective observational study including patients with confirmed diagnosis of acute appendicitis. C-reactive protein (CRP), procalcitonin, cell blood count, including white blood cell (WBC), absolute neutrophil (ANC) and immature granulocyte (IG) count and EIP (neutrophil reactivity [NEUT-RI] and granularity intensity [NEUT-GI]) were analyzed before surgery. Their accuracy to diagnose complicated appendicitis was tested in an ROC curve analysis. ResultsOur population study included 119 patients, and appendicitis was complicated in 58 (48.7%). NLR, CRP and procalcitonin levels, ANC and IG count and NEUT-RI and NEUT-GI were higher in patients with complicated appendicitis. Regarding accuracy for complicated appendicitis, CRP was the biomarker with the highest performance (ROC AUC: 0.829), with an optimal cutoff of 73.1 mg/L (sensitivity: 63.8%, specificity: 88.5%). NEUT-RI and NEUT-GI achieved both significant but poor accuracy, with ROC AUC of 0.606 and 0.637, respectively. ConclusionsNovel laboratory tests reported by Sysmex XN-Series analyzers have poor accuracy for identifying complicated appendicitis. In this study, CRP was the biomarker with the highest performance and may be useful as predictor of the severity of acute appendicitis.

The Outcome of Laparoscopic Versus Open Appendectomy in Childhood.

Appendectomy in children is performed either lapa - roscopically (LA) or by open surgery (OA). We studied whether, and how, the outcome is affected by the technique used and by the intraoperative conversion of LA to OA. We analyzed routine data from children and adolescents in three age groups (1-5 years, 6-12 years, and 13-17 years) who were insured by the AOK statutory health insurance carrier in Germany and who underwent appendectomy in the period 2017-2019. General surgical complications and reoperations within 90 days were assessed with relevant indicators. Associations between the surgical technique and these indicators were studied with logistic regression. Of the 21 541 patients included in the study, general surgical complications were observed in 2.1% and reoperations in 1.8% overall. Broken down by age group, the corresponding figures were 5.4% and 4.4% (age 1 to 5), 2.5% and 1.8% (age 6 to 12), and 1.5% and 1.6% (age 13 to 17). The main risk factors for complications and reoperations were acute complicated appendicitis and conversion from LA to OA. Regression analysis revealed similar outcomes with OA compared to LA in the 1-to-5 age group, (odds ratios and 95% confidence intervals: 1.1 [0.6; 2.1] for general surgical complications and 1.5 [0.8; 2.7] for reoperations), but worse outcomes with OA in the other two age groups (age 6 to 12: 1.9 [1.2; 2.9] and 2.1 [1.5; 2.9]; age 13 to 17: 1.7 [1.0; 2.9] and 2.2 [1.4; 3.6]). When conversions were assigned to the LA group, the odds ratio (OA compared to LA) for reoperation across all age groups was 3.5 [2.8; 4.4] in patients with acute uncomplicated appendicitis and 4.2 [3.4; 5.3] in patients with complicated appendicitis. Complicated appendicitis also increased the rate of general surgical complications and the length of stay in hospital. Among children in the two older age groups, LA was followed by fewer general surgical complications and reoperations than OA. These differences were less pronounced when conversions were counted as belonging to the LA group. Children aged 1-5 appear to benefit the least from the lapa - roscopic technique.

Diagnostic accuracy of doctors at the emergency department and radiologists in differentiating between complicated and uncomplicated acute appendicitis.

To determine the accuracy of final judgements of doctors at the emergency department (ED) and radiologists to differentiate between complicated and uncomplicated acute appendicitis, because these have different treatment options. This prospective, multicenter study included adult patients with imaging-confirmed acute appendicitis, operated with intention to appendectomy. Both doctors at ED and radiologists assessed appendicitis severity as a final judgement of "uncomplicated" or "complicated" appendicitis. Doctors at ED integrated clinical, laboratory, and imaging findings. Radiologists relied solely on imaging findings. Outcomes were accuracy of these judgements for diagnosis of complicated appendicitis compared to the reference standard by an adjudication committee. After imaging, 1070 patients with confirmed acute appendicitis were included. Doctors at ED accurately labelled 656 of 701 (93.6%) patients with true uncomplicated appendicitis as uncomplicated, and 163 of 369 (44.2%) patients with true complicated appendicitis were labelled as complicated. Sensitivity, specificity, and positive and negative predictive values (PPV and NPV) for complicated appendicitis were 44.2%, 93.6%, and 78.4% and 76.1%, respectively. Comparable accuracy was found for the radiologist's assessment in 941 patients, with true positive rates of 92.2% (581 of 630 patients) for uncomplicated appendicitis and 46.6% (145 of 311 patients) for complicated appendicitis. More than half of all patients with true complicated appendicitis is incorrectly classified as uncomplicated appendicitis according to the judgements of doctors at ED, integrating clinical, laboratory, and imaging results, and of radiologists assessing diagnostic imaging. These judgements are thereby not sufficiently reliable in ruling out complicated appendicitis.

Identification of complicated and non-complicated appendicitis: a new alvarado-based scoring system.

In the presence of non-complicated appendicitis, treatment typically involves a simple appendectomy and can even be managed medically. However, in cases of complicated appendicitis, surgery becomes more difficult, and the morbidity and mortality rates increase. This study aims to develop a method for recognizing complicated acute appendicitis operatively. This retrospective study developed a scoring system based on the Alvarado score. Several variables were scored in this new scoring system, including the Alvarado score, female gender, elevated direct bilirubin, increased appendicitis thickness, and the presence of complications as evidenced by imaging or appendicoliths. The study included a total of 404 patients with a mean age of 38.50±12.94 years, all operated on for acute appendicitis. Of these, 45.8% were female. Complicated acute appendicitis was present in 25% of the patients. The presence of complicated acute appendicitis was identified with a sensitivity of 86.1% and a specificity of 90.4% in patients who scored 10.5 or above. It is critical to identify perioperative and postoperative complications, provide appropriate patient counseling, and consider medical treatment when appropriate to diagnose acute complex appendicitis effectively. The new scoring system is an effective method for recognizing acute complicated appendicitis.

Sensitivity and specificity of neutrophil-to-lymphocyte ratio in pediatric patients with acute complicated appendicitis

Sensitivity and specificity of neutrophil-to-lymphocyte ratio in pediatric patients with acute complicated appendicitis

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.

Elevated total and direct bilirubin are associated with acute complicated appendicitis: a single-center based study in Saudi Arabia

BackgroundAppendicitis is the most common abdominal surgical emergency and up to our knowledge no previous studies have been conducted in Saudi Arabia particularly at Qassim region and this study aimed to determine a total and direct bilirubin as a predictor of acute complicated appendicitis.MethodsObservational retrospective study that included patients admitted under the general surgery department with a diagnosis of acute appendicitis at King Saud Hospital, Unaizah, Saudi Arabia. Data on age, gender, BMI, diabetes mellitus, total and direct bilirubin, AST, ALT, sodium, and WBCs levels were obtained.ResultAmong the overall study population of 158 patients, the age median [IQR] was 24.5 [19–31], males were 99 (62.7%), and complicated appendicitis was 33 (20.9%). The multivariable analysis revealed that both elevated total and direct bilirubin are associated with complicated appendicitis (aOR = 3.79, 95% CI: 1.67–8.48, P = 0.001) and (aOR = 4.74, 95% CI: 2.07–10.86, P < 0.001) respectively. A receiver operating characteristic curve showed the best cutoff value of total and direct bilirubin as ≥ 15 µmol/L and ≥ 5 µmol/L respectively, with a sensitivity of 57.6%, and specificity of 73.6% for elevated total bilirubin, and a sensitivity of 54.6%, and specificity of 80% for elevated direct bilirubin.ConclusionElevated total and direct bilirubin are associated with acute complicated appendicitis in this setting. However, it should be supportive factor for acute complicated appendicitis and not considered as standalone diagnostic test.

A Rare Case of Cecostomy Tube in Complicated Acute Appendicitis Leading to Fecal Peritonitis

The most common abdominal surgical emergency in the world in acute appendicitis. Most common age group involved is between first to second decades but patients at extreme age have higher mortality rate due to late presentation. We are presenting a case of appendicitis which was complicated as long history at time of first surgery which led to caecal injury which was managed with ceacostomy. 62 years gentleman was referred from private hospital with fecal discharge from the open appendectomy wound and cecostomy tube insitu. Patient was diagnosed as phlegmon sequelae of acute appendicitis. Patient underwent emergency laparotomy, peritoneal lavage, removal of cecostomy tube, primary repair of caecal perforation and diversion loop ileostomy. Patient recuperated well. This case report highlights the challenges faced and complexities associated with failure of cecostomy in managing caecal perforation following laparoscopic appendectomy. The conversion from a laparoscopic approach to an emergency open appendectomy followed with cecostomy proved to be a vital decision in the face of phlegmon sequelae of acute appendicitis. The phlegmonous nature of acute appendicitis should be managed conservatively otherwise leading to a more aggressive surgical intervention. Keywords: Acute appendicitis, cecostomy, ileostomy, fecal discharge, phlegmon, complicated appendicitis.

The burden of the knowledge-to-action gap in acute appendicitis

BackgroundThe burden of emergency general surgery (EGS) is higher compared to elective surgery. Acute appendicitis (AA) is one of the most frequent diseases and its management is dictated by published international clinical practice guidelines (CPG). Adherence to CPG has been reported as heterogeneous. Barriers to clinical implementation were not studied. This study explored barriers to adherence to CPG and the clinico-economic impact of poor compliance.MethodsData were extracted from the three-year data lock of the REsiDENT-1 registry, a prospective resident-led multicenter trial. We identified 7 items from CPG published from the European Association of Endoscopic Surgery (EAES) and the World Society of Emergency Surgery (WSES). We applied our classification proposal and used a five-point Likert scale (Ls) to assess laparoscopic appendectomy (LA) difficulty. Descriptive analyses were performed to explore compliance and group comparisons to assess the impact on outcomes and related costs. We ran logistic regressions to identify barriers and facilitators to implementation of CPG.ResultsFrom 2019 to 2022, 653 LA were included from 24 centers. 69 residents performed and coordinated data collection. We identified low compliance with recommendations on peritoneal irrigation (PI) (25.73%), abdominal drains (AD) (34.68%), and antibiotic stewardship (34.17%).Poor compliance on PI and AD was associated to higher infectious complications in uncomplicated AA. Hospitalizations were significantly longer in non-compliance except for PI in uncomplicated AA, and costs significantly higher, exception made for antibiotic stewardship in complicated AA. The strongest barriers to CPG implementation were complicated AA and technically challenging LA for PI and AD. Longer operative times and the use of PI negatively affected antibiotic stewardship in uncomplicated AA. Compliance was higher in teaching hospitals and in emergency surgery units.ConclusionsWe confirmed low compliance with standardized items influenced by environmental factors and non-evidence-based practices in complex LA. Antibiotic stewardship is sub-optimal. Not following CPG may not influence clinical complications but has an impact in terms of logistics, costs and on the non-measurable magnitude of antibiotic resistance. Structured educational interventions and institutional bundles are required.

Clinical outcomes in patients with complicated appendicitis.

Complicated appendicitis (appendicitis with abscess, perforation, or generalized peritonitis) poses a significant burden on healthcare systems, with incidence up to 28-29%. Current management options include antibiotic therapy and up-front surgery, antibiotic therapy and percutaneous drainage, or antibiotic therapy alone. There is no consensus on treatment guidelines in current literature. This study aims to better define treatment algorithms for patients presenting with acute complicated appendicitis by evaluating clinical outcomes in those treated with or without surgery. We performed a single-institution, retrospective review of 220 adult patients (≥ 18years old) treated for acute complicated appendicitis from January 2017 to June 2022. Demographic and clinicopathologic variables were collected and analyzed. We compared patients who were managed non-operatively versus operatively. Regression modeling was used to determine factors associated with non-operative management (NOM) and those predictive of failure of NOM. Our analysis showed 26.3% patients with acute complicated appendicitis underwent NOM (n = 58), versus 73.6% underwent operative management at index admission (n = 162). Within the NOM group, 55.1% patients were treated with antibiotics alone (n = 32) versus 44.8% with percutaneous drainage (n = 26). Within the operative cohort, 88.7% of patients underwent appendectomy (n = 142). Age, body mass index, comorbidities, vital signs and laboratory values on admission were similar between both groups. Clinical factors predictive of initial NOM were perforation (OR 7.9, 95% CI 3.7-16.5) and phlegmon (OR 6.3, 95% CI 2.8-14.1) at presentation. Clinical factors predictive of failure of NOM requiring surgery on index admission or within 30days was larger abscess and/or phlegmon size (OR 1.76, 95% CI 1.0-3.0). There may be a role in identifying clinical factors in patients with complicated appendicitis that favor non operative versus operative management. Larger abscess and/or phlegmon size could be a predictor of failure of NOM.

Value of total leucocytic count and pelvic-abdominal ultrasound in distinguishing complicated from noncomplicated acute appendicitis

Background Complicated appendicitis is associated with elevated rates of morbidity and mortality compared with noncomplicated appendicitis. In this study, we aimed to investigate the role of combining total leucocytic count (TLC) and abdominal ultrasound (US) in distinguishing simple from complicated appendicitis. Patients and methods This is a prospective study that included patients with acute appendicitis who underwent appendectomy. The patients’ data regarding demographic characteristics, clinical, laboratory, and US findings, as well as intraoperative findings and postoperative complications, were recorded and analyzed. Results This study included 80 patients. Overall, 48 (60%) patients had noncomplicated appendicitis, and 32 (40%) had complicated appendicitis. Patients with complicated appendicitis had significantly higher ages and TLC. Concerning the US findings, significantly higher cases of visualized blind-ended loop (P = 0.042), right iliac fossa fluid (P = 0.006), and pelvic collection (P &lt; 0.001) were shown in the complicated group. Multiple regression analysis revealed that TLC and the presence of pelvic collection by the US were the only variables significantly predicting complicated appendicitis. Adopting either a TLC cut-off value of 12.95×109/l and/or the presence of pelvic collection for the diagnosis yielded a sensitivity of 90.6%, a specificity of 77.1%, and an accuracy of 82.5%. Conclusion The presence of a TLC cut-off value of 12.95×109/l and/or a pelvic collection in abdominal ultrasound seems to be reproducible for the preoperative prediction of complicated acute appendicitis.

A New Marker In The Diagnosis Of Acute Complicated Appendicitis In Adult Patients: Neutrophil/Albumin Ratio

ABSTRACT&#x0D; Aim: Our study aims to search the effectiveness of neutrophil/albumin ratio (NAR) in distinguishing between acute appendicitis (AA) and acute complicated appendicitis (ACA) and to find the best cut-off point of neutrophil/albumin ratio (NAR) for the diagnosis of ACA.&#x0D; Material and method: This study was performed using data from 453 adult patient who underwent appendectomy and divided into two groups as AA and ACA. Demographic data, preoperative white blood cell count (WBC), neutrophil lymphocyte ratio (NLR), neutrophil/albumin ratio (NAR), C-reactive protein value (CRP) surgical outcomes, and pathological outcomes were retrospectively assessed for each groups.&#x0D; Results: In our study, 362 patients were in the AA group and 91 patients were in the ACA group. WBC, NLR, CRP and NAR were significant parameters in differentiating acute appendicitis from acute complicated appendicitis. Among these parameters, NAR; AUROC sensitivity and specificity values were stronger than others. (AUROC: 0.963, sensitivity: 95.6%, specificity: 85.7%). As a result of the ROC curve analysis, a cut-off value of 2.79 mg/dl was found. &#x0D; Conclusion: NAR is a novel inflammatory marker simply detected through routine preoperative blood results, with no additional time or cost. The neutrophil/albumin ratio (NAR) is a fast, easy to access and reliable parameter to differentiate AA from ACA.

Soluciones antisépticas en la prevención de infección de herida quirúrgica en pacientes operados por apendicitis aguda complicada

Surgical wound infection secondary to complicated acute appendicitis is frequent. The objective was to compare the Dakin and the Superoxidative solutions to prevent surgical wound infections in complicated acute appendicitis. It was a comparative, cross-sectional study, in 104 patients with complicated acute appendicitis (medium age 36.29 years, 69(66.43%) men). Group 1: 52 patients with surgical wound lavage with Dakin modified solution. Group 2: 52 patients with superoxidative solution (Microdacyn®). All patients received ceftriaxone 1 g before surgery; conventional appendectomy was performed and the wall closure with Vicryl 1 and Nylon 2/0. Surgical wound was evaluated 7 days after surgery, looking for pus, edema, erythema, local heat. X2 and Student's t were used. Surgical wound infection was present in 11 (10.6%) patients, 3(5.8%) patients from group 1 and 8(15.4%) from group 2 (p=0.1). Both solutions are useful to prevent surgical wound infections in patients operated by complicated acute appendicitis.

Diagnostic performance of type I hypersensitivity-specific markers combined with CRP and IL-6 in complicated acute appendicitis in pediatric patients

ObjectiveIn this study, the diagnostic value of C-reactive protein (CRP), interleukin-6 (IL)-6, and specific markers for type I hypersensitivity were evaluated in pediatric patients with severe acute appendicitis. MethodsA total of 140 pediatric patients with “acute appendicitis” who underwent surgery at the Department of General Surgery of the Anhui Provincial Pediatric Patients' Hospital between December 2022 and April 2023 were studied retrospectively. The data collected included the gender, age, onset time, white blood cell count (WBC), CRP, procalcitonin (PCT), serum IgE, serum IL-4, serum IL-5, serum IL-6, serum IL-9, and serum IL-13 levels. The pediatric patients were divided into two groups based on the intraoperative situation and postoperative pathology: the non-complicated acute appendicitis group (NCAA) and the complicated acute appendicitis group (CAA). We analyzed the data from both groups using univariate and multivariate logistic regression models and constructed an ROC curve. ResultsThe CAA group outperformed the NCAA group in terms of onset time, WBC, CRP, PCT, IgE, IL-6, IL-9, and IL-13 levels (P < 0.05), but there was no statistically significant difference between the two groups in terms of gender, IL-4, or IL-5 levels (P > 0.05). Then, significant independent variables were incorporated into multivariate logistic regression. According to the results, CRP, IgE, IL-6, and IL-13 are all independent risk factors for CAA. The OR and 95% CI for each factor are as follows: CRP (OR = 1.073, 95%CI: 1.010–1.140, P = 0.022), IgE (OR = 0.975, 95%CI: 0.952–0.999, P = 0.038), IL-6 (OR = 1.494, 95%CI: 1.052–2.121, P = 0.025), and IL-13 (OR = 1.310, 95%CI: 1.036–1.657, P = 0.024). The receiving operator characteristics analysis yielded area under the curve (AUC) values of 0.8187, 0.9083, 0.8947, and 0.8394, respectively, for CRP, IgE, IL-6, and IL-13, confirming their significance in the diagnosis of CAA (P < 0.05). ConclusionRisk factors for CAA include CRP, IgE, IL-6, and IL-13. The combination of these serological markers can be used to diagnose CAA.

Flow cytometric characterization of cecal appendix lymphocyte subpopulations in children: a pilot study

IntroductionScientific literature regarding the characterization of lymphocyte subpopulations of the cecal appendix is sparse, with few precedents limited to immunohistochemical techniques.MethodsWe conducted a prospective pilot study to characterize lymphocyte subpopulations of the cecal appendix in children. Participants were divided into three groups: (1) patients without histological acute appendiceal inflammation, (2) patients with histological uncomplicated acute appendicitis, and (3) patients with histological complicated acute appendicitis (gangrenous, perforated). A fresh sample of the base of the appendix was taken from all patients and a flow cytometric study was performed. Quantitative variables were compared using Kruskal–Wallis test and Mann–Whitney U test.ResultsThis study included 57 patients divided into Group 1 (n = 5), Group 2 (n = 37), and Group 3 (n = 15). Median values (IQR) of the percentage of B-lymphocytes were 67.8 [66.8–68.1] in group 1, 61.15 [53.74–66.4] in group 2, and 52.1 [33–62.02] in group 3 (p = 0.02). Median values (IQR) of the percentage of NK-lymphocytes were 0.26 [0.2–0.3] in group 1, 0.55 [0.37–0.66] in group 2, and 0.84 [0.35–1.45] in group 3 (p = 0.008). Median values (IQR) of the percentage of T-lymphocytes were 31.9 [31.7–33.1] in group 1, 37.68 [32.15–45.69] in group 2, and 46.9 [37.03–67] in group 3 (p = 0.02). Pair comparisons of groups 2 and 3 also showed significant differences in the percentage of B lymphocytes (p = 0.03) and NK-lymphocytes (p = 0.02).ConclusionsSignificant differences in lymphocyte subpopulations were identified according to the histologic grade of the cecal appendix. More specifically, a lower percentage of B-lymphocytes and a higher percentage of T- and NK-lymphocytes were observed in cases of acute appendicitis. These findings must be confirmed and their etiopathogenic, diagnostic, and prognostic implications elucidated in future studies with larger sample sizes.