Diagnosis Of Acute Appendicitis Research Articles

Presence of Sonographic Secondary Signs Without Visualization of Appendix Is Indicative of Appendicitis in Children Younger Than 5 Years.

Diagnosis of acute appendicitis is more difficult in children aged 0-4 years due to atypical clinical presentation, leading to delay in diagnosis and higher incidence of complications. Nonvisualization of the appendix on ultrasound increases diagnostic challenge. We examined the utility of standardized reporting of sonographic secondary signs of appendicitis in children younger than 5 years with nonvisualization of the appendix. A retrospective cohort study of children younger than 5 years who underwent appendectomy following nonvisualization of the appendix on ultrasound from 2016 to 2022 was performed. Primary outcome was comparison of ultrasound and intraoperative findings. Two-sample t test and Wilcoxon sum-rank test compared continuous variables, and Fisher exact test compared categorical variables. Univariate and multivariate logistic regression analyses were performed to assess risk factors for complicated appendicitis in those with category 3 ultrasounds. Overall, 92 patients whose appendix was not visualized on ultrasound were included: 26 without secondary signs (category 2) and 66 with secondary signs (category 3). Significant differences in intraoperative findings between category 2 and category 3 patients existed (P < 0.001). On intraoperative assessment of patients with ultrasound category 2, 3.8% had no appendicitis, 46.2% had simple appendicitis, 34.6% had complicated appendicitis, and 15.4% underwent interval appendectomy. Conversely, of category 3 patients, 0% had no appendicitis, 7.6% had simple appendicitis, 48.5% had complicated appendicitis, and 43.9% underwent interval appendectomy. On logistic regression, in children with category 3 ultrasounds, presence of both fluid collection and free fluid as secondary signs was associated with intraoperative findings of complicated appendicitis. However, number of secondary signs was not significantly associated with increased likelihood of complicated appendicitis intraoperatively. Presence of secondary signs without visualization of the appendix was shown to be indicative of appendicitis, with high suspicion for complicated appendicitis, in patients younger than 5 years. Further validation of the presence of secondary signs on right-lower-quadrant ultrasound may lead to more expedient diagnosis, reduction in cross-sectional imaging, and earlier treatment of complicated appendicitis.

What you need to know: Current management of acute appendicitis in adults

ABSTRACT Acute appendicitis is one of the most common acute surgical diseases in the world today. Acute appendicitis can present with a well-recognized clinical presentation with abdominal pain which localize in the right lower quadrant. This presentation is more typical in men than in women of child baring age. Several clinical and laboratory calculations can be used to increase the likelihood of making a correct diagnosis. Various imaging modalities can be used to make the diagnosis which include ultrasound, computer tomography, and magnetic resonance imaging. Each study has well known sensitivity/specificity of positive predictive value of making the diagnosis of appendicitis. The management of acute appendicitis is based on the presentation of the patient and dividing it into uncomplicated and complicated disease. Each requires management with antibiotics and followed with timely appendectomy. Recent studies have demonstrated nonoperative management of uncomplicated appendicitis without no fecalith that can be managed with antibiotics alone. Complicated acute appendicitis should undergo timely surgical intervention. Patients presenting with a large appendiceal abscess or phlegmon should undergo percutaneous drainage and antibiotic management. There are certain patient populations that should be considered for surgical intervention. Pregnant patients as well as immunosuppressed patients should undergo timely surgical intervention to decrease the risk of complications. This review outlines the current principles of the diagnosis, imaging, and treatment of acute appendicitis based on the best available evidence of acute appendicitis in adults. LEVEL OF EVIDENCE Original Review Article, Level III.

Diagnostic value of biochemical markers in prediction of perforation in acute appendicitis: a cross-sectional study.

Acute appendicitis, despite being the most common surgery, can result in increased morbidity and mortality in the case of perforated appendicitis. Identifying a perforation early can reduce the impact on the patient. Bilirubin, C-reactive protein (CRP), and white blood cell (WBC) count have been shown to indicate perforation in appendicitis. A cross-sectional analytical study was conducted to observe the association between preoperative bilirubin, CRP, and white cell count with the histological findings of either the presence or absence of perforation of the appendix. The eligibility criteria included all patients above 18 years with appendicitis who were managed surgically in the study hospital, Shree Birendra Hosptial, between 1 December 2021 to 30 May 2022. The study was conducted after the approval from the ethics committee. Out of 150 patients, 112 had open surgery and 38 underwent laparoscopic appendectomy. One hundred thirty-four had non-perforated appendix and 16 cases had perforated appendix. The older age group was associated with appendiceal perforation more than the younger age group. Patients with a duration of symptoms less than 24 h and more than 72 h developed perforated appendicitis less frequently. The odds of encountering perforated appendicitis increased by 2.644 times per 0.972 rise in total bilirubin (P= 0.004) and the odds of encountering perforated appendicitis increased by 6.474 times per 1.868 rise in conjugated bilirubin (P= 0.003). There was no significant difference in total leucocyte count and neutrophil percentage among perforated and non-perforated groups. The diagnostic value of the CRP, total bilirubin, and conjugated bilirubin levels was strong and significant when used in combination rather than their individual performance in the diagnosis of perforated acute appendicitis.

COMPARISON OF ALVARADO, RIPASA, AND AIR SCORING SYSTEM IN DIAGNOSIS OF ACUTE APPENDICITIS

Accurate and timely diagnosis of acute appendicitis is critical in preventing complications and guiding surgical intervention. The Alvarado, RIPASA, and AIR scoring systems are commonly used diagnostic tools, each with varying performance metrics in different clinical settings. Objective: This study aimed to compare the diagnostic performance and overall accuracy of the Alvarado, RIPASA, and AIR scoring systems for diagnosing acute appendicitis. Methods: This observational study was conducted at Civil Hospital Karachi from December 2023 to May 2024, following ethical approval from the institutional review board. A total of 200 patients aged over 18 years presenting with clinical symptoms suggestive of acute appendicitis were included in the study through non-probability consecutive sampling. Each patient’s data was analyzed using the Alvarado, RIPASA, and AIR scoring systems to evaluate their diagnostic accuracy, sensitivity, specificity, and area under the curve (AUC). Results: The Alvarado score demonstrated a sensitivity of 88.44%, a specificity of 37.04%, and an overall accuracy of 81.50%, with an AUC of 0.667 (p=0.002). The RIPASA score showed a sensitivity of 81.18%, a specificity of 53.33%, and an accuracy of 77.00%, with an AUC of 0.699 (p=0.001). The AIR score displayed a sensitivity of 81.00%, a specificity of 60.00%, and an accuracy of 82.00%, with an AUC of 0.700 (p&lt;0.001). Conclusion: The Alvarado, RIPASA, and AIR scores each demonstrate diagnostic value in identifying acute appendicitis, though their sensitivity and specificity may vary based on the population and clinical setting. Clinicians should consider these variations when selecting a scoring system to optimize diagnostic accuracy for acute appendicitis.

Appendectomy for suspected appendicitis during pregnancy– a retrospective comparative study of 99 pregnant and 1796 non-pregnant women

IntroductionSuspected appendicitis is the most common indication for non-obstetric surgery during pregnancy. Diagnosis and management of these patients can be challenging. Atypical clinical presentation has been described before, but the current literature consists mostly of small case series. Therefore, we conducted a large retrospective study to analyze the frequency and diagnostic accuracy of clinical signs, laboratory findings and imaging modalities in pregnant woman undergoing surgery for suspected appendicitis compared to a control group of non-pregnant women of childbearing age. We further describe intra- and postoperative findings in both groups.MethodsData from consecutive patients who underwent appendectomy for suspected appendicitis during pregnancy were retrieved from the electronic patient database and analyzed. Preoperative clinical, laboratory and imaging findings as well as intra- and postoperative characteristics were compared between pregnant and non-pregnant women.ResultsBetween January 2008 and June 2023, 99 pregnant woman and 1796 non-pregnant woman between the ages of 16 and 49 underwent emergency surgery for suspected appendicitis. Pregnant women were less likely to have right lower quadrant tenderness (p = 0.002), guarding (p = 0.011) and rebound tenderness (p = 0.097). A greater percentage of pregnant women had a symptom duration of more than 24 h before presentation (p = 0.003) Abdominal ultrasound showed a reduced diagnostic accuracy in pregnant women (p = 0.004). MRI was used in eight pregnant women and showed a diagnostic accuracy of 100%. Pregnant women had a longer operating time (p = 0.006), a higher rate of open appendectomies or conversion (p < 0.001) and a longer postoperative hospital stay (3.2 days vs. 2.2 days, p < 0.001). The perforation rate was also higher in pregnant women at 16% vs. 10% (p = 0.048).ConclusionThe diagnosis of acute appendicitis during pregnancy presents a challenge for the clinician. Our data confirm the paradigm of “atypical presentation” which should lead to an extended diagnostic workup. Ultrasound showed less diagnostic accuracy in pregnant women in our study. MRI is a useful tool to reduce uncertainty and the rate of negative appendectomies.

Unveiling patterns in pediatric appendectomy: A comparative study on healthcare resource capacity and surgical decisions in Brazil.

Appendicitis is the most prevalent surgical emergency in children. This study examined hospital infrastructure, surgical techniques, patient demographics, and hospitalization parameters to assess the provision of safe and adequate care within the Brazilian public healthcare system. Pediatric hospitalizations for acute appendicitis in 2022 were extracted from the Brazilian national database. We included all hospitalizations for patients aged 0-16years with a primary ICD-10 diagnosis of acute appendicitis who underwent an operation. Parameters of interest were the type of surgical approach, mortality, and total cost of hospitalization. Facilities were defined as basic-facility, full-facility, and pediatric according to the level of pediatric resources available. In 2022, there were 29,983 pediatric appendectomies due to acute appendicitis. Of these, 90.2% were open appendectomies. Most occurred in basic-facility general hospitals (53.0%), followed by full-facility (35.2%) and pediatric hospitals (11.8%). Full-facility hospitals had a higher median cost (USD126.3, IQR 99.5-154.4) compared to basic (USD96.8, IQR 87.6-130.1) and pediatric hospitals (USD103.0, IQR 91.9-117.5), though the cost difference between basic and pediatric was not significant (p=0.367). Death was a rare event across all levels of hospital infrastructure and for all types of procedures performed. The majority of hospitalizations for acute appendicitis occurred in hospitals with minimal pediatric infrastructure. Open appendectomies remain the most predominant procedure across all hospital types.

Using a sum of the cross diameters of the appendix measured on ultrasonographyas a criterion can more effectively predict acute appendicitis.

To investigate whether usingasum of the cross diameters on the transverse section of the appendix as a criterioncan improve the diagnosis of acute appendicitis (AA). In this retrospective study, 433 patients with AA and 207 patients with a normal appendix were assigned to the training and validation groups in a proportion of 7:3. Each group was divided into subgroups consisting of patients with AA and a normal appendix. The training group included 144 patients with a normal appendix and 302 patients with AA, while the validation group comprised 63 patients with a normal appendix and 131 patients with AA. Graded compression ultrasound was performed to evaluate the appendix, and the cross diameters on the transverse section were measured, with one of them used as the maximum outer diameter (MOD). The cut-off value of the sum of cross diameters for predicting AA was 13.5 mm or more. When it was applied to evaluate the appendix in the training group, a sensitivity of 98.7%, specificity of 99.3%, positive predictive value of 99.7%, negative predictive value of 97.3%, and an area under the receiver operating characteristic curve of 0.990 were achieved. Which were significantly higher than those (except for a sensitivity of 99.3%) obtained using the criteria of MOD ≥ 6 mm. Similar results were obtained in the validation group. Using a sum of cross diameters of the appendix of 13.5 mm or more as a criterionto diagnose AA can yield excellent diagnostic performance, and can replace the current criteria of MOD of 6 mm or more. Question A MOD of the appendix ≥ 6 mm is a recommended criterion for diagnosing AA, but often results in a false-positive diagnosis. Findings Using the sum of the cross diameters of the appendix ≥ 13.5 mm as acriterionyielded significantly higher diagnostic performance than the recommended criteria. Clinical relevance The sum of the cross diameters of the appendix is a better criterion for the evaluation of patients with suspected AA, exhibiting significantly higher diagnostic performance than the MOD of the appendix.

Primary signet ring cell carcinoma of the appendix presenting as gangrenous appendicitis with peritonitis: A case report

Introduction and clinical importance: Primary signet ring cell carcinoma (SRCC) of the appendix is an exceedingly rare malignancy with a non-specific clinical manifestations, and it often masquerades as acute appendicitis. Case presentation A 76-year-old man presented with acute abdominal pain and peritonitis. Abdominal computed tomography revealed relative acute appendicitis with peritonitis, and emergency laparoscopic partial cecectomy with appendectomy revealed gangrenous appendicitis with perforation. A histopathological examination revealed a primary appendiceal signet ring cell carcinoma (PASRCC). Clinical discussion: This case highlights the importance of considering appendiceal malignancies in the differential diagnosis of acute appendicitis. SRCC is a histological variant commonly associated with multiple malignancies of the gastrointestinal tract, particularly gastric and colorectal cancers. Conclusion: PASRCC is a rare malignancy presenting with symptoms indistinguishable from those of acute appendicitis. Clinicians should maintain a high index of suspicion for appendiceal malignancy, particularly in older patients with atypical clinical presentations. Early recognition, accurate diagnosis by histopathological and immunohistochemical examinations, and appropriate management are essential for optimizing the outcomes in these patients.

Usability of presepsin, Calprotectin and interleukin 6 in the diagnosis of acute appendicitis

Objective This study aimed to evaluate presepsin, calprotectin, and interleukin-6 levels together in terms of their utility in the diagnosis of acute appendicitis and distinguishing complicated acute appendicitis cases. In addition, it was attempted to identify a biomarker that would be most useful in diagnosing acute appendicitis. Methods This study was conducted prospectively at the emergency department of a tertiary hospital. Patients diagnosed with AA from July 3, 2023, through January 1, 2024, were evaluated. 45 patients with acute appendicitis and 45 healthy volunteers were included in the study. Presepsin, calprotectin, and interleukin-6 levels were measured in both groups and subjected to statistical analyses. Results To ensure equality between the two groups participating in the study, 17 female and 28 male patients were included in each group. The presepsin, calprotectin, and interleukin-6 levels of the patients with appendicitis were significantly higher than those of the healthy group (p < 0.001 for all). However, presepsin, calprotectin, and interleukin-6 were not significant parameters in differentiating between complicated and uncomplicated appendicitis (p = 0.493, p = 0.202, and p = 0.448, respectively). Conclusion Presepsin, calprotectin, and interleukin-6 levels may be useful in diagnosing acute appendicitis but would be insufficient in identifying complicated cases.

Appendicitis in children: correlation between the surgical and histological diagnosis

PurposeStudy was designed in order to evaluate the discrepancies between surgical and histological diagnosis in pediatric acute appendicitis (AA) and to compare the outcomes of laparoscopic (LA) and open appendectomies (OA).MethodsIn a retrospective observational cohort, AA patients were included under 18 years of age, operated between 2011 and 2020. Surgical diagnosis was defined by the operating surgeon. The histological findings were classified as uncomplicated and complicated AA. The LOS and complications were also statistically analyzed.ResultsAltogether, 1444 patients were included. Significant strong correlation and a moderate to substantial agreement were found between the surgeon’s and the histopathological findings in all appendectomy cases (weighted kappa value in OA: 0.633, LA: 0.639, total sample: 0.637). If the surgeon’s diagnosis was less severe than the pathologist’s, the LOS was 4 (3;7) days, whereas if the surgical diagnosis was correct, the LOS was 3 (3;5) days (p < 0.0001).ConclusionsIn contrary to the literature, our study revealed a strong correlation and moderate agreement between the intraoperative and histopathological findings regarding the severity of AA. Complicated cases are distinctly recognizable during the surgery. In case the surgeon underestimates the severity of AA, the chance of complications is higher.Level of evidence: II

RIPASA Score versus Pediatric Appendicitis Score in Diagnosis of Acute Appendicitis in Pediatric Patients

RIPASA Score versus Pediatric Appendicitis Score in Diagnosis of Acute Appendicitis in Pediatric Patients

A Prospective Comparative Study on the Clinical Diagnostic Performance of Blood Inflammatory Markers in Acute Appendicitis.

Despite the substantial advancements in imaging techniques for the diagnosis and differential diagnosis of acute appendicitis (AA) over recent decades, the specificity and sensitivity of widely utilized laboratory biomarkers in clinical practice remain inadequate.This study aimed to investigate the diagnostic utility of commonly employed blood inflammatory markers for AA. A total of 399 participants who either sought medical care or underwent health examinations were enrolled in this prospective study. The cohort comprised 200 patients diagnosed with AA (AA group), 100 patients presenting with abdominal pain but without AA (AP group), and 99healthy individuals undergoing routine health check-ups (HC group). For all subjects, the following biomarkers were measured: plasma neutrophil gelatinase-associated lipocalin (NGAL), white blood cell count (WBC), neutrophil count (NEU), percentage of neutrophils (NEU%), neutrophil-to-lymphocyte ratio (NLR), and C-reactive protein (CRP). The diagnostic performance of the observed indicators, both individually and in combination, was assessed for the diagnosis of AA using Receiver Operating Characteristic (ROC) curves analysis and Delong's test. The laboratory indicators demonstrated a progressive increase from the HC group to the AP group, and further to the AA group (all p<0.05). Multifactorial logistic regression analysis identified NEU% and plasma NGAL as significant risk factors for the occurrence of AA. ROC curve analysis and Delong's test indicated that, in distinguishing the AA group from the HC group, the diagnostic performance of plasma NGAL, CRP, and NLR was equally substantial and superior to that of NEU and WBC. Within the AP group, plasma NGAL and CRP exhibited comparable diagnostic efficacy, outperforming NEU, WBC, and NLR. When differentiating AA in the non-appendicitis group (ie HC group + AP group), NGAL and CRP demonstrated comparable diagnostic efficacy, surpassing that of NEU, white WBC, and NLR. While the integration of multiple diagnostic tests can potentially improve overall diagnostic accuracy, the observed enhancement in the AUC is not statistically significant. NGAL, CRP, WBC, NEU% and NLR were significantly increased in patients with acute abdomen. NGAL and NEU% may function as independent risk factors for predicting the incidence of AA, with NGAL and CRP demonstrating similar and favorable diagnostic performance. While the combined evaluation of these biomarkers may enhance the diagnostic value for AA, the improvement in the area under the curve (AUC) is not substantial.

HYPERBILIRUBINEMIA: A NEW DIAGNOSTIC MARKER FOR ACUTE APPENDICITIS AND ITS PART IN PREDICTING APPENDICULAR PERFORATION

Introduction:Acuteappendicitis is the commonest cause of Acute Surgical abdomen.Appendicectomy is the most frequently performed urgent abdominal operation and is often the first major procedure performed by a surgeon in training. Aims&amp;Objectives:The objectives of the study were-To study the relationship between hyperbilirubinemia and acute appendicitis and to evaluate its credibility as a diagnostic marker for acute appendicitis. Materials&amp;Methods:The study was conducted in the Department of General Surgery, HKEs Basaveshwar Teaching and General Hospital, kalaburagi attached to MahadevappaRampure Medical College, kalaburagi during the period of August 2022 to August 2023. A one year cross sectional study. Results:A total of 100 patients with clinical diagnosis of acute appendicitis or appendicular perforation admitted in the Department of General surgery, HKEs Basaveshwar Teaching &amp; General Hospital, kalaburagi attached to MahadevappaRampure Medical College, kalaburagi were studied. Discussion:Acute appendicitis is the most common cause of acute abdomen in young adults. Appendicectomy is the most frequently performed urgent abdominal operation and is often the first major procedure performed by a surgeon in training.PPAbout 8% of people in Westerncountries have appendicitis at some time in their lifetime. Conclusion: The present study suggests-Serum bilirubin levels appears to be a promising new laboratory marker for diagnosing acute appendicitis, however diagnosis of appendicitis remains essentially still - clinical. Its level come out tobe a credible aid in diagnosis of acute appendicitis and would be helpful investigation in decision making.

Surgical aspects of pediatric abdominal pain in the era of COVID-19: clinical consideration and outcomes.

Acute abdominal pain in pediatrics is a medical emergency that requires special attention. During COVID-19 pandemic, this disease presented in pediatric age by different presentations including abdominal presentations.The affected children are presented with abdominal pain, which may be caused by surgical causes or by the virus itself that necessitate surgical consultation. This study highlights the impact of the coronavirus pandemic on pediatric patients with acute abdominal pain regarding the presentation, clinical evaluation, and surgical management. A retrospective cohort study was done through the collection of data from medical records and authors' data repositories of pediatric patients presented with acute abdomen from March 2020 to March 2022, in three pediatric surgery tertiary centers. Eighty-four pediatric patients with acute abdominal pain were included in this study. The diagnosis of acute appendicitis was found in 31 patients (36.9%). Generalized abdominal pain was noted in 17 patients (20.2%) and presentation mimicked acute cholecystitis was occured in 14 patients (16.7%). ultrasonography revealed intussusception in 12 cases (14.3%). Multisystem inflammatory syndrome in children (MIS-C) was present in 9 cases (10.7%) and only one case of pancreatitis (1.2%). Conservative management was successful in 66 cases (78.6%), while operative intervention was needed in18 cases (21.4%). During the COVID-19 pandemic, acute abdominal pain in children was frequently observed. Careful follow up is critically important as most cases do not necessitate surgical intervention. It is crucial to consider COVID-19 as a differential diagnosis in children presenting with acute abdominal pain, particularly in cases of atypical appendicitis and intussusception to prevent unnecessary surgical procedures.

Appendiceal Neoplasm in Conservatively Managed Acute Appendicitis: A Retrospective Observational Study.

Introduction Appendiceal neoplasms are more prevalent in patients ≥ 40 years old who present with complicated appendicitis, especially if managed conservatively. Routine interval appendicectomy is not recommended. Follow-up bowel screening using both a CT scan and colonoscopy is recommended. Following the COVID-19 pandemic, many units have increased their utilization of non-operative management of acute appendicitis (NOM).This provides an optimal population sample to study the incidence of unexpected appendiceal malignancy compared to a similar cohort that underwent operative management. The primary outcomes of interest include the incidence of appendiceal malignancy following NOM, efficacy of bowel screening, and rates of re-admission. Methods A retrospective, observational study on patients admitted with acute appendicitis from January 2020 to December 2021. All patients diagnosed with acute appendicitis aged 40 years and older were included in the study, while those under 40 or without a diagnosis of acute appendicitis were excluded. Results We had 211 cases of acute appendicitis. 125 (59%) of which were managed operatively, while 86 cases (41%) were managed NOM. We found six cases (7%) of appendiceal malignancy in the NOM cohort, compared to two cases (1.6%) in the operatively-managed cohort. A routine follow-up colonoscopy failed to reveal any sinister pathology. All six cases underwent interval appendicectomy through which the malignancy was detected. 39 cases (45%) of NOM had at least one episode of re-admission, with 32 (37%) of them being in the first year. Conclusion NOM of acute appendicitis in adults ≥ 40 years old is associated with an increase in unexpected appendiceal malignancy, none of which were detected on follow-up colonoscopy.We emphasize the need for closer surveillance and potentially more aggressive follow-up strategies, including routine interval appendicectomy, for older patients undergoing NOM of acute appendicitis.

The diagnostic value of systemic inflammation indices in pregnant women with acute appendicitis and their relationship with the duration of hospital stay

Aim: Physiological and anatomical changes occurring during pregnancy can complicate the diagnosis of acute appendicitis (AA). This study aimed to evaluate the diagnostic performance of systemic inflammation indices in distinguishing AA in pregnant women and to assess their relationship with hospital stay duration. Material and Methods: This retrospective study encompassed 32 pregnant patients who underwent appendectomy and 32 healthy pregnant (control group). Systemic inflammation indices were calculated based on neutrophil (N), platelet (P), and lymphocyte (L) levels as follows: The neutrophil-to-lymphocyte ratio (NLR) = N/L; the platelet-to-lymphocyte ratio (PLR) = P/L; systemic immune-inflammation index (SII) = (N×P)/L. Results: The AA group had higher median levels of PLR (30.9 vs. 22.4, p = 0.035), NLR (6.1 vs. 3.5, p &lt; 0.001), and SII (1370 vs. 807, p &lt; 0.001) compared to the control group. Systemic inflammation indices showed a positive correlation with the Alvarado score and the length of hospital stay. SII values demonstrated superior diagnostic performance in predicting AA compared to NLR and PLR values. The threshold value for SII in predicting AA was identified as &gt;1316, with a sensitivity of 85.8% and a specificity of 72.5%. Conclusions: Systemic inflammation indices, particularly SII, demonstrate strong diagnostic value in distinguishing AA in pregnant women. SII demonstrated superior accuracy over NLR and PLR, correlating with both the Alvarado score and hospital stay, suggesting its utility as a diagnostic and prognostic marker.

Assessment of diagnostic value of ultrasound and multi-slice spiral computed tomography in acute appendicitis: a retrospective study.

Ultrasound and multi-slice spiral computed tomography (CT) are frequently used to assist the diagnosis of acute appendicitis (AA), and the examination results may vary among different demographics. This study aimed to compare the diagnostic accuracy of ultrasound and CT for AA. We performed a retrospective analysis of patients diagnosed with AA who underwent emergency surgery at our hospital from March 2021 to August 2023, with postoperative pathological results as the gold standard. Differences in the diagnostic accuracy of ultrasound and CT for different types of AA, age groups, and body mass index (BMI) values were then analyzed. The overall sample comprised 279 confirmed cases of AA, with 64 cases of simple appendicitis, 127 cases of suppurative appendicitis, and 88 cases of gangrenous appendicitis. For these three pathological classifications, the diagnostic accuracy of ultrasound was 68.75% (44/64), 73.22% (93/127), and 81.81% (72/88), respectively, while the diagnostic accuracy of CT was 71.87% (46/64), 82.67% (105/127), and 90.90% (80/88), respectively. There was no statistically significant difference in the overall diagnostic accuracy between the two methods (P > 0.05). Subgroup analysis showed no difference in diagnostic accuracy between the two methods for patients with normal BMI (P > 0.05). However, for overweight, obese, and elderly patients, CT provided significantly better diagnostic accuracy than ultrasound (P < 0.05). While ultrasound and CT have similar diagnostic accuracy for different pathological types of AA, CT is more accurate for overweight, obese, and elderly patients.

Appendicitis in Children: Does Age Really Matter?

Acute appendicitis (AA) is a frequent and emergent surgical abdominal condition that presents some particularities and challenges in young children. Data of 402 children aged <16 years with a confirmed diagnosis of AA were retrospectively reviewed. Included patients were divided into two groups: Group A (preschool children aged ≤5 years, n = 44) and Group B (school children aged >5 years, n = 358). Clinical presentation, biological findings, calculated diagnosis scores (paediatric appendicitis score [PAS] and Alvarado score), intraoperative findings and outcomes were comparatively analysed between the two groups. Children of Group A had more likely fever, bowel disorders, diffuse abdominal pain and diffuse tenderness than those of Group B (P = 0.001, P = 0.005, P = 0.006 and P = 0.001, respectively). Regarding biomarkers, the mean of white blood cell count and C-reactive protein levels was higher in Group A than in Group B (18,849 cell/mm3 and 162.8 mg/L in Group A versus 15,938 cell/mm3 and 86.7 mg/L in Group B, P = 0.003 and < 0.001, respectively). The mean of calculated PAS and Alvarado scores was higher in Group A than in Group B (8.2 ± 1.1 and 8.2 ± 1 vs. 7.5 ± 1.4 and 7.4 ± 1.5, P = 0.003 and P = 0.001, respectively). Most children with a calculated PAS and Alvarado score equal to or higher than 8 belonged to Group A (PAS: 84.1% vs. 58.4%, P = 0.001, Alvarado score: 84.1% vs. 55.6%, P < 0.001). The perforation of the appendix was seen in 77.3% of Group A patients and only in 41.5% of children in Group B (P < 0.0001). The mean length of stay was 5.1 ± 1.9 days in Group A and 4.3 ± 2.8 days in Group B but without any statistical difference between the two groups (P = 0.094). AA in preschool children is associated with atypical presentation and rapid progression of the disease making the early diagnosis mostly challenging in our settings.

Role of Ultrasonography in the Diagnosis of Acute Appendicitis

Introduction: Acute appendicitis is still prevalent as a major surgical emergency. Due to the fast progress of the ailment, surgery is often the most sensible approach to manage it. But any surgery comes with its fair share of risk. If the diagnosis of the disease can be made more accurate prior to surgery, the error rate of negative appendectomy can be greatly reduced. Aim of the study: The aim of the study was to evaluate the role of ultrasonography in the diagnosing acute appendicitis. Methods: This prospective cross-sectional study was conducted at the Institute of Nuclear Medicine &amp; Allied Sciences (INMAS), Rangpur with Department of Surgery &amp; Department of Pathology of Rangpur Medical College Hospital, Rangpur, Bangladesh. The study duration was 02 years, from 01January 2022 to 31 December 2023. A total of 100 cases were selected from those patients were come for ultrasound examination, send from the hospital with pain in the right lower quadrant of the abdomen for the purpose of this study. Result: Among the 100 participants of the study, histopathological diagnosis showed that 86% were acute appendicitis cases and 14% had normal appendicitis. Gender or age had no significant association with histopathological diagnosis, but male prevalence was observed in the study, with a high prevalence of young adults. The original site of pain was periumbilical pain shifted to the right iliac fossa for half the participants. Pain duration was between 18-24 hours for 36% of the cases. All participants presented with pain, fever, anorexia, and nausea had a high prevalence among participants. The sensitivity and specificity of high-resolution ultra-sonogram were 84.9% and 85.7% respectively. Conclusion: Appendicitis is a disease of the young, and can occur in participants of both genders. Histopathological diagnosis has no significant association with patient age or gender. Ultra-sonogram has high sensitivity and specificity ratio in diagnosing acute appendicitis and also h

WP1.17 - Double Trouble - A Case of Duplex Appendix

Abstract Introduction Duplex appendix, a rare anatomical anomaly is often encountered incidentally during appendicectomy procedures. It is characterised by the presence of two appendiceal lumens and can be classified using the Cave-Wallbridge classification system. Case An 18-year-old male presents to the Emergency Department with a two-day history of migratory right iliac fossa pain. He was consented and booked for a laparoscopic appendicectomy based on clinical suspicion of acute appendicitis. Intra-operatively, an unexpected finding surfaces—a second pendunculated mass adjacent to the inflamed appendix. Employing laparoscopic linear staples, both the appendix and the adjacent mass were divided. One day post-discharge, the patient presents with severe abdominal pain and computed tomography imaging suggests an intra-abdominal leak. The patient underwent an emergency laparotomy and ileo-caecal resection overnight. Histology revealed the second pedunculated mass was indeed a second appendix, a phenomenon with a reported incidence of 0.004 to 0.009%. Discussion Addressing the nuances of using imaging modalities in the diagnosis and operative planning of acute appendicitis, our discussion raises pertinent questions regarding the necessity of definitive pre-operative imaging in suspected cases. Considering potential pitfalls of incorrect clinical diagnoses; the presence of anatomical anomalies; and other factors influencing surgical decision-making; we scrutinise the proposition of pre-operative imaging protocols in suspected acute appendicitis. Conclusively our case encapsulates the diagnostic and therapeutic conundrums posed by duplex appendix instances, prompting a deeper exploration into the use of imaging techniques in a traditionally clinically diagnosed presentation and the implications thereof in surgical management.