Diagnosis Of Acute Appendicitis Research Articles

Pathological Assessment of the Appendix in Appendectomies Performed in Children.

Acute appendicitis is known as the most common diagnosis of acute abdomen leading to surgery. Therefore, timely diagnosis is of special importance. This study was conducted with the aim of pathological assessment of the appendix in appendectomies performed in children to determine the rate of negative appendectomies and the predictors of negative appendectomy and to evaluate the paraclinical tools used in the diagnosis of acute appendicitis. This is a cross-sectional descriptive study. All children who underwent appendectomy at Shahid Motahari Hospital in Urmia from March 2021 to March 2022 were examined. The required data including demographic, paraclinical, and final pathology characteristics were collected and recorded. The investigated cases were classified into positive and negative appendectomy categories for comparison. Among 234 pathology samples of the appendix, 22 cases were related to accidental appendectomy. In addition, 11.3% of cases were negative appendectomy and 88.7% were positive appendectomy. The age range of 8 to 14 years and male gender were associated with a lower negative appendectomy rate (both P<0.001). Inflammatory (49.5%) and gangrenous appendicitis (30.2%) were the most commonly reported histopathologies. Sonography had a sensitivity of 84%, a specificity of 79%, and an overall diagnostic accuracy of 83%. A relatively significant number of accidental and negative appendectomies are performed. More careful investigation and the use of expectant and medical treatment instead of surgery, especially in females and young children, can be effective in improving diagnostic accuracy and preventing negative appendectomies.

Correlational study of Hyperbilirubinemia as a diagnostic predictor for perforation in acute appendicitis

Background: Appendicitis is an acute and life-threatening situation if not treated promptly encountered in surgery practice. Even today, most cases of appendicitis are diagnosed by clinical findings and imaging. Scanty information is available to diagnose the perforation of the appendix using serological tests; hence, an attempt is made. The present study aimed to find out the correlation of hyperbilirubinemia as a diagnostic predictor for perforation in acute appendicitis patients. Methods: This prospective observational study was conducted among patients diagnosed with acute appendicitis attending OPD of the general surgery department of Narayana Medical College Hospital. The duration of the study is between January 2023 and December 2023. A total of 400 patients with a diagnosis of either acute appendicitis or perforation were recruited into the study, and they collected blood samples for estimation of hyperbilirubinemia. Results: In the study population of 400 patients, 72 cases were diagnosed as appendicular perforation, and 328 patients had acute appendicitis. The cut-off value of hyperbilirubinemia was taken as serum bilirubin &gt;1.0 mg/dl. Out of 72 cases of appendicular perforations, 64 patients have hyperbilirubinemia (89%), while in the acute appendicitis patients group, 82 of 328 patients have elevated serum bilirubin (25%). The observed mean values of serum bilirubin in the two groups were 1.74 and 0.89, and the difference in the standard error of the mean value of the two groups is statistically significant at a P-value of &lt;0.001. Conclusions: Patients who presented with acute appendicitis symptoms and had serum bilirubin values &gt;1.0 mg/dl had a higher probability of appendicular perforation. Hence, measuring serum bilirubin can be considered an additional diagnostic tool to existing clinical diagnosis and radiological evaluation for more precision in diagnosis.

Effectiveness of Ultrasonography and Computed Tomography in the Diagnosis of Acute Appendicitis

Background: Acute appendicitis is the acute inflammation of the appendix vermiformis and is one of the leading emergency intra-abdominal surgeries. In the study; To investigate the effectiveness of preoperative USG and CT in the diagnosis of acute appendicitis. Materials and Methods: The records of 332 patients who underwent appendectomy between March 2018 and March 2023 were retrospectively examined. Gender, age, USG and CT reports and patho-logy results of the patients were recorded. Sensitivity, specificity, positive predictive value and negative predictive values of USG and CT in the diagnosis of acute appendicitis were calculated separately. Results: The pathology result was reported as acute appendicitis in 312 of the patients, and was evaluated as normal in 20 of them. The pathology result of 254 of 261 patients, whose CT results were evaluated as compatible with acute appendicitis, was reported as acute appendicitis. In 7 patients, it was found to be normal appendicitis. Of 28 patients whose CT results were incompatible with acute appendicitis, the pathology result was positive in 18 and negative in 10. Pathology results of 96 patients whose USG results were compatible with acute appendicitis; Acute appendicitis was found in 90 patients and normal appendix in 6 patients. Pathology results of 41 patients whose USG results were evaluated as negative; It was reported to be compatible with acute appendicitis in 36 cases and normal in 5 cases. Conclusions: In our study, both the sensitivity and specificity of CT were found to be superior to USG, consistent with the literature. Researching IT effectiveness; We think that prospective studies com-paring teleradiology reports and the reports of radiologists working in hospitals would be useful.

Epidemiology, Seasonal Variability, and Factors Associated with Increased Mortality in Patients with Acute Appendicitis in Thailand: A Study Using Data from the National Health Security Office

Objective: The study aimed to study the spatiotemporal distribution of acute appendicitis in Thailand, using a reimbursement dataset from the National Health Security Office, and also analyze for mortality and factors associated with mortality after an appendectomy.Material and Methods: The study used data mining to analyze a reimbursement data set from the Thailand National Health Security Office (NHSO), focusing on the diagnosis of acute appendicitis (K35.2-K35.9). The analysis looked for the incidence trend and seasonal variation of the incidence. The study also analyzed mortality and factors associated with the mortality. A prediction model for mortality was constructed using a decision tree. Results: During the 4 fiscal years of the study period, from October 2016 - September 2020, a total of 287,449 individuals were diagnosed with acute appendicitis, and 272,850 appendectomies were performed, which gave an annual incidence (AI) of 10.8/10,000 person-years. The peak age incidence was in the second decade of life, which had an age-specific AI of 28.4/10,000 person-years. Using a multiplicative model of time series detrending and a decomposition model and a seasonal variation of acute appendicitis, with the highest incidence from May to October, linear regression showed a significant correlation between the incidence of appendicitis and precipitation (r2=0.28, p-value&lt;0.001). The AI of appendicitis was declining and showed an especially large decline in the year 2020, when the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic began. The overall mortality was 2.3%. A significantly higher mortality rate was found in cases with extreme age (pediatric or geriatric), those with co-morbidities (diabetes, hypertension, dyslipidemia, chronic pulmonary disease, chronic kidney disease), and those with complications, especially generalized peritonitis, sepsis, and acute kidney injury. A decision-tree prediction model suggested that sepsis and renal complication were key nodes determining mortality risk in pediatric and geriatric appendicitis. Conclusion: A mortality risk from appendicitis remains in Thai patients, especially the elderly with co-morbidities and those with generalized peritonitis, sepsis, or renal complications. Early diagnosis and improvement in perioperative care in the extreme age groups might improve the mortality figure.

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

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

Accuracyof Ultrasound and CT scans in the Diagnosis of Acute Appendicitis in Children: A Systematic Review

Accuracyof Ultrasound and CT scans in the Diagnosis of Acute Appendicitis in Children: A Systematic Review

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

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

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

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

Reactive Protein can be use as a Diagnostic Tool for Acute Appendicitis

Background: Diagnosing and treating appendicitis is a common surgical emergency.Based on a thorough history, physical examination, test results, and imaging studies, an accurate diagnosis of acute appendicitis can be made. Correct diagnosis is frequently challenging since the patient's age and the location of the appendix might affect the clinical presentation. This study aimed to determine the C- reactive protein's clinical usefulness as an appendicitis diagnostic test.Materials and Methods: An eight (08) months cross-sectional study was performed done between March and October, 2021. The study was conducted at the tertiary care hospital. In this study, 116 patients were included. Clinical details, examination, and history were noted. All patients having negative HBsAg, and Anti-HCV, required emergency surgery irrespective of age and gender were included in the study. All collected data were entered and analyzed through Microsoft Excel 2016.Results: A total of 116 appendicitis patients were studied in which majority patients were in age range from 18-30 years with 62.1% and 37.9% were observed in age between 31 to 45 years. Male patients were found frequently with 56.9%. CRP was positive in majoritypatients with 84.4% acute appendicitis.Conclusion: Acute appendicitis is not likely to be recognized in preoperative instances with increased CRP values. When a patient is suspected of having acute appendicitis, a standard laboratory test assessing CRP should be implemented. Acute appendicitis can bediagnosed with this test and utilized as a surgical indication marker.

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

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

Accuracy and Sensitivity of RIPASA Score in Diagnosis of Acute Appendicitis

Accuracy and Sensitivity of RIPASA Score in Diagnosis of Acute Appendicitis

Comparison of miRNA profiles in the immune response of pediatric acute appendicitis and pediatric enterobiasis patients caused by Enterobius vermicularis.

The aim of this study was to determine and compare the miRNA profile in the immune response with the parasite in pediatric patients with acute appendicitis caused by Enterobius vermicularis and in pediatric patients with enterobiasis. A total of 30 tissue samples, which were operated with the diagnosis of pediatric acute appendicitis in the last 10 y and Enterobius vermicularis was detected by histopathological findings, were analyzed. In addition, blood samples were taken from 30 pediatric patients diagnosed with enterobiasis for this study. The miRNAs that activate T and B cells were evaluated by a quantitative real-time PCR, statistically calculated within ΔΔCt values, and fold changes were evaluated by Welch's T test, in which p<0.5 was considered to be significant. It was found that 48 out of 136 (35.3%) miRNAs differed between the pediatric patient and healthy control groups. It was determined that 22 (57.9%) of the different miRNAs were T cell activating miRNAs and 26 (68.4%) were B cell activating miRNAs. While there was a significant difference in miRNA values activating T cells in two patient groups (p<0.01), there was no significant difference in miRNA values activating B cells (p>0.01). In the study, although Enterobius vermicularis was the causative agent in both patient groups, it was revealed that the immune response of patients with acute appendicitis was more affected than enterobiasis patients.

Neuroendocrine tumor of the appendix masquerading as acute appendicitis with a mucocele on CT scan: a rare finding

IntroductionNeuroendocrine tumors (NETs) of the appendix are rare and are often discovered incidentally during surgery for acute appendicitis or other unrelated conditions (Modlin et al. in Gastroenterology 128:1717–1751, 2005, Alsaad et al. in Oncol Rep 16:1105–1109, 2006, Frilling et al. in Lancet Oncol 15:e8–e21, 2014). These tumors can range from asymptomatic incidental findings to clinically significant tumors with metastases (Alsaad et al. in Oncol Rep 16:1105–1109, 2006, Gomes et al. in World J Emerg Surg 10:60, 2015, Paiva et al. in Eur J Cancer 38:702–705, 2002, Burke et al. in Am J Surg Pathol. 9:661–674, 1985). This case report presents a rare case of a NET of the appendix presenting as acute appendicitis.Case descriptionA 23-year-old male presented with right lower quadrant abdominal pain, nausea, and vomiting for 2 days. A CT scan revealed a mucocoele of the appendix. The patient underwent laparoscopic appendectomy, and the appendix was sent for histopathological examination. The final pathological report confirmed a NET of the appendix with a Ki-67 index of 1% and no lymphovascular invasion. Due to tumor invasion to the cecum and its large size (3–4 cm), the patient underwent right hemicolectomy. The final histopathology report of the resected specimen confirmed the diagnosis of NET of the appendix.DiscussionThe clinical diagnosis of NETs of the appendix can be challenging due to their rarity and non-specific presentation. Symptoms of NETs of the appendix can mimic those of acute appendicitis, making it difficult to differentiate between the two conditions. Imaging studies, such as CT scans, can provide valuable information about the size and location of the tumor (Gomes et al. in World J Emerg Surg 10:60, 2015, Maggard et al. in Ann Surg 240:117–122, 2004, Burke et al. in Am J Surg Pathol. 9:661–674, 1985, Frilling et al. in Lancet Oncol 15:e8–e21, 2014). However, the definitive diagnosis is made through histopathological examination of the resected specimen. The treatment of NETs of the appendix depends on factors such as the size, location, and grade of the tumor. Small tumors confined to the appendix with no lymph-vascular invasion can be treated with appendectomy alone, while larger tumors or those that have spread beyond the appendix may require more extensive surgery, such as right hemicolectomy (Gomes et al. in World J Emerg Surg 10:60, 2015, Mestier et al. in Dig Liver Dis 52:899–911, 2020, Maggard et al. in Ann Surg 240:117–122, 2004, Burke et al. in Am J Surg Pathol. 9:661–674, 1985, Frilling et al. in Lancet Oncol 15:e8–e21, 2014, Pavel et al. in Neuroendocrinology 103:172–185, 2016). In some cases, additional treatments such as chemotherapy or radiation therapy may be recommended.ConclusionThis case report emphasizes the importance of considering NETs of the appendix in the differential diagnosis of acute appendicitis. Imaging studies can provide valuable information, but the definitive diagnosis is made through histopathological examination. The treatment approach for NETs of the appendix depends on various factors and requires a multidisciplinary approach for optimal management.

Artificial intelligence in the diagnosis and treatment of acute appendicitis: a narrative review.

Artificial intelligence is transforming healthcare. Artificial intelligence can improve patient care by analyzing large amounts of data to help make more informed decisions regarding treatments and enhance medical research through analyzing and interpreting data from clinical trials and research projects to identify subtle but meaningful trends beyond ordinary perception. Artificial intelligence refers to the simulation of human intelligence in computers, where systems of artificial intelligence can perform tasks that require human-like intelligence like speech recognition, visual perception, pattern-recognition, decision-making, and language processing. Artificial intelligence has several subdivisions, including machine learning, natural language processing, computer vision, and robotics. By automating specific routine tasks, artificial intelligence can improve healthcare efficiency. By leveraging machine learning algorithms, the systems of artificial intelligence can offer new opportunities for enhancing both the efficiency and effectiveness of surgical procedures, particularly regarding training of minimally invasive surgery. As artificial intelligence continues to advance, it is likely to play an increasingly significant role in the field of surgical learning. Physicians have assisted to a spreading role of artificial intelligence in the last decade. This involved different medical specialties such as ophthalmology, cardiology, urology, but also abdominal surgery. In addition to improvements in diagnosis, ascertainment of efficacy of treatment and autonomous actions, artificial intelligence has the potential to improve surgeons' ability to better decide if acute surgery is indicated or not. The role of artificial intelligence in the emergency departments has also been investigated. We considered one of the most common condition the emergency surgeons have to face, acute appendicitis, to assess the state of the art of artificial intelligence in this frequent acute disease. The role of artificial intelligence in diagnosis and treatment of acute appendicitis will be discussed in this narrative review.

Accuracy and sensitivity of RIPASA score Versus Alvarado score in diagnosis of acute appendicitis.

Accuracy and sensitivity of RIPASA score Versus Alvarado score in diagnosis of acute appendicitis.

Accuracy of ultrasonography in diagnosis of acute appendicitis at King Chulalongkorn Memorial Hospital

Accuracy of ultrasonography in diagnosis of acute appendicitis at King Chulalongkorn Memorial Hospital

Bilharzial Appendicitis: About A Case, at the District Hospital of Commune IV of Bamako

Bilharzial appendicitis is a very rare condition. We report the case of a young 18-year-old adolescent admitted to the department for pain in the right iliac fossa in a febrile context, evolving for 8 days with a history of terminal hematuria. After an abdominal ultrasound, the diagnosis of acute appendicitis was made. Treatment consisted of an appendectomy. The pathological examination revealed eggs of Schistosoma hematobium at the level of the appendicular wall. An antiparasitic treatment based on praziquantel was started. The postoperative course was simple.

Beyond acute appendicitis: a single-institution experience of unexpected pathology findings after 989 consecutive emergency appendectomy.

Appendiceal neoplasms (ANs) are rare, with an estimated incidence of around 1%: neuroendocrine tumours (NETs) and low-grade appendiceal mucinous neoplasms (LAMNs) comprise most cases. Most tumours are cured by appendectomy alone, although some require right hemicolectomy and intra-operative chemotherapy. The aim of the present study is to evaluate our institution's experience in terms of the prevalence of AN, their histological types, treatment and outcomes in adult patients undergoing emergency appendectomy. Single-centre retrospective cohort analysis of patients treated for acute appendicitis at a large academic medical centre. Patients with a diagnosis of acute appendicitis (AA) where further compared with patients with acute appendicitis and a histologically confirmed diagnosis of appendiceal neoplasm (AN). A diagnosis of acute appendicitis was made in 1200 patients. Of these, 989 patients underwent emergency appendectomy. The overall incidence of appendiceal neoplasm was 9.3% (92 patients). AN rate increased with increasing age. Patients under the age of 30 had a 3.8% (14/367 patients) rate of occult neoplasm, whereas patients between 40 and 89years and older had a 13.0% rate of neoplasm. No difference was found in clinical presentations and type of approach while we found a lower complicated appendicitis rate in the AN group. ANs are less rare with respect to the literature; however, clinically, there are no specific signs of suspicious and simple appendicectomy appears to be curative in most cases. However, age plays an important role; older patients are at higher risk for AN. ANs still challenge the non-operative management concept introduced into the surgical literature.

A Comparative Study of RIPASA and ALVARADO Scoring Systems in the Diagnosis of Acute Appendicitis

A Comparative Study of RIPASA and ALVARADO Scoring Systems in the Diagnosis of Acute Appendicitis

Accuracy of point-of-care ultrasound in the diagnosis of acute appendicitis in a pediatric emergency department.

To investigate the accuracy of point-of-care ultrasound (PoCUS) in diagnosing acute appendicitis in children; to evaluate the concordance between PoCUS performed by a pediatric emergency physician (PedEm) and ultrasonography (US) performed by a radiologist; to draw a "learning curve." We prospectively enrolled children aged 0-14 years old led to the Emergency Department of Regina Margherita Children's Hospital, from January 2021 to June 2021, with suspected acute appendicitis. PoCUS was performed by a single trained PedEm, blindly to the radiologist's scan. A "self-assessment score" and the "time of duration of PoCUS" were recorded for each patient. Final diagnosis of appendicitis was made by a pediatric surgeon. We enrolled 62 children (2-14 years). Overall sensitivity of PoCUS was 88%, specificity 90%; PPV 90.6%, and NPV 86.6%. Global concordance between the PedEm and the radiologist was good/excellent (k 0.74). The mean duration of PoCUS significantly decreased during the study period, while the self-assessment score increased. This is a preliminary study that shows the effectiveness of PoCUS in diagnosing acute appendicitis; furthermore, it shows how the PedEm's performance may improve over time. The learning curve showed how the experience of the PedEm affects the accuracy of PoCUS.