Diagnosis Of Acute Appendicitis Research Articles

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 PROSPECTIVE STUDY TO COMPARE THE POST-OPERATIVE PAIN AND POST-OPERATIVE COMPLICATIONS IN CONVENTIONAL GRID IRON AND TRANSVERSE CREASE COSMETIC INCISION APPENDECTOMY

Objective: The objective of our study is to compare the conventional grid iron incision with transverse crease cosmetic incision in terms of post-operative pain, mean operating time, duration of hospital stay, and post-operative complications. Methods: This is a prospective and comparative study and was carried out between December 2021 and November 2022. During the study period, 50 patients presented to surgical outdoor and emergency at PBM hospital, Bikaner, with clinical presentation and eventual radiological diagnosis of acute appendicitis were enrolled in the study and were randomly allocated to two groups including grid iron=25 and transverse crease=25. All patients were contacted 1 week and 2 months after surgery and the efficacy of grid iron and transverse crease incision in terms of post-operative pain, mean operating time, duration of stay in hospital, and post-operative complications. Results: Post-operative pain, duration of stay in hospital (mean stay for grid iron group=4.32 vs. transverse crease group=2.16 days), and operating time (mean operating time for grid iron group=33 min vs. transverse crease group was 20.3 min) were significantly lower in cases of transverse crease incision as compared to grid iron cases. Post=operative complications were lesser in transverse crease incision but were not very significant as compared to grid iron incision. Conclusion: Open appendectomy using transverse crease cosmetic incision was superior to conventional grid iron incision in terms of post-operative pain, operating time, duration of hospital stay, blood loss, and post-operative complications.

A STUDY OF CLINICOPATHOLOGICAL PROFILE IN PATIENTS OF APPENDICULAR PERFORATION

Introduction: Appendicular perforation is one of the most common surgical emergencies. The diagnosis of appendicular perforation is based on clinical history, examination combined with investigation. Hb, total leukocyte count (TLC), and neutrophil USG CT help in confirming the diagnosis. Methods: A prospective study was conducted on patient coming with appendicular perforation, at a tertiary care center. Included subject underwent a through physical and clinical evaluation. Data were collected in performa and statistical analysis was done by applying the appropriate test. Results: Among 100 cases of operated appendectomy, great number of patients belonged to 11–20 years (40%) with male predominance (72%). Among all, 90% were diagnosed as histopathological examination positive (appendicular perforation). Sixty-nine percent (69%) patients were C-reactive protein (CRP) positive. Increased TLC in 70% of patients and raised neutrophilia in 54% of patients was observed. Out of 100 patients, 86% were USG positive and retrocecal appendix was the most common position. Tenderness at RIF was the most common sign present (100%). Rovsing’s sign was present in 25% cases while 15% cases were noted with obturator test. Majority of them (70%) had score of &gt;7 and were diagnosed as modified Alvarado-positive cases. Conclusion: In our study, the combination of CRP, TLC, and neutrophil count has PPV of 100% which signifies their greater diagnostic accuracy in early diagnosis of acute appendicitis while the NPV after combining this test is 100% which signifies negative appendectomy can be decreased, if appendectomy is avoided in cases where TLC, CRP, and NC are normal.

Management of Acute Appendicitis in Children in a University Hospital.

Little is known about the positive predictive value of diagnostic tools for severe acute appendicitis (AA). Our objective was to study a retrospective cohort of patients with AA, emphasizing its laboratory and radiologic features, to establish risk factors for more severe cases of AA. A retrospective cohort study with patients with AA confirmed by biopsy was performed. In each case, examinations were reviewed, data were compared, and laboratory and radiologic findings were established to identify risk factors for severe AA. During the studied period, 405 children, with a mean age of 120 months, were evaluated. Most of the patients were boys (63.2%). C-reactive protein was the best parameter for the diagnosis of perforated AA, with a sensitivity of 88% for values above 173 mg/dL. A total of 64.4% of the patients underwent abdominal ultrasound, and 26% had normal results. Acute appendicitis is a disease with a wide spectrum of complications; thus, it is important to recognize the markers associated with severe cases of AA. High levels of C-reactive protein were the best markers associated with perforated appendicitis, and ultrasound was requested in most of the cases but was not helpful in most of them.

COMPARISON OF RIPASA AND ALVARADO SCORING SYSTEM IN DIAGNOSIS OF ACUTE APPENDICITIS IN TERTIARY CARE

Introduction: Acute appendicitis is one of the most common surgical emergencies, with a lifetime prevalence rate of approximately one in seven. Different techniques have been devised to assist in equivocal cases in attempts to decrease negative appendectomy rates. RIPASA and ALVARADO scores are new diagnostic scoring systems for diagnosis of acute appendicitis . RIPASA scoring system has more sensitivity, specificity and diagnostic accuracy than ALVARADO score in diagnosis of acute appendicitis in Asian population. Hence this study conducted to compare RIPASA AND ALVARADO score in diagnosis of acute appendicitis in tertiary care hospital. RIPASA score includes more parameters than ALVARADO score such as age, gender, duration of symptoms prior to presentation Aims and objectives: To compare RIPASA and Alvarado score in diagnosing acute appendicitis using histopathology as gold standard Materials and Methods: Source of Data: Basaveshwar teaching and general hospital from august 1st to 30th september 2022 Study Design: Prospective observational study. Study Population: 74 patients Inclusion criteria All patients who presented with right lower quadrant abdomen pain and diagnosed as acute appendicitis. Exclusion Criteria: Patients under 18 years of age. Patients with right iliac fossa mass. Patients with features of peritonitis All these patients were scored as per RIPASA and Alvarado scoring system after taking history , clinical examination and laboratory investigations. RIPASA includes 18 parameters and Alvarado 8 parameters. A score of 7.5 taken as high probability of acute appendicitis as per RIPASA and score of 7 for Alvarado scoring system. The decision of appendicectomy solely based on surgeonÂ’s own clinical judgement After the surgery, histopathological reports of operated cases correlated with scoring systems.

The Efficacy of Appendicitis Inflammatory Response Score in Diagnosis of Acute Appendicitis

Background: Acute appendicitis is one of the most common cause of acute abdominal pain. The management of suspected appendicitis represents a prime target for improved decision-making in emergency surgical care (OPD, Emergency room). The aim of the work is to evaluate the appendicitis inflammatory response (AIR) score and compare its performance in predicting the risk of appendicitis to the Alvarado score. Objective: To evaluate the diagnostic performance of the AIR score and potential benefits of risk stratification to guide clinical decision making. Methods: This prospective observational study was conducted in the OPD and Emergency department, Sir Salimullah Medical College &amp; Mitford Hospital, Dhaka. From June’2021 to May’2022. A total 240 patients with right lower abdominal pain. History, clinical examination, hematological, radiological investigations were done. AIR score was calculated. Considering histopathology report as gold standard the score was compared. Histopathology report was done in Pathology Department of SSMC, Dhaka. Results: Right iliac fossa pain (100%) was the most common symptom, followed by vomiting (58.3%), temperature (29.5%), and rebound tenderness. After applying AIR scorings, 44(18.3%) patients in low-risk group (0-4), 112(46.7%) patients in the intermediate risk group (5-8) and 84(35.0%) patients in the high-risk category (9-12). Amongst the 240 applying the AIR score, Sensitivity of inflammatory response score vs histopathology findings was 97.9%, specificity 78.4%, accuracy 93.8%, positive and negative predictive values were 94.4% and 90.9% respectively. Conclusion: Risk stratification of patients with suspected appendicitis by the AIR score could guide decision-making to reduce admissions, length of hospital stay, cost and case fatality rate, optimize utility of diagnostic imaging and to decrease negative exploration. Sir Salimullah Med Coll J 2023; 31: 47-52

Association of Total Leucocyte Count and Acute Appendicitis Among Young Patients Undergoing Emergency Appendectomy

Objective: To study the association of total leucocyte count and acute appendicitis among young patients undergoing emergency appendectomy. Study Design: Comparative cross-sectional study. Place and Duration of Study: Department of Surgery, Combined Military Hospital, Quetta Pakistan, from Mar to Oct 2021. Methodology: The study included one hundred patients diagnosed with acute appendicitis by a consultant surgeon undergoing an emergency appendectomy. The total leucocyte count was calculated for all the patients at the time of diagnosis. The treating surgeon confirmed acute appendicitis findings based on gross examination of the appendix at the time of surgery. The presence of acute appendicitis and other factors was associated with raised total leucocyte count in all the patients. Results: Out of 100 patients diagnosed with acute appendicitis, 59 were male, while 41 were female. The mean age of the study participants was 28.33±3.673 years. On gross examination, 79 had a confirmed diagnosis of acute appendicitis, while 21 did not have an inflamed appendix. 85 had raised total leucocyte count, while 15 patients had total leucocyte count in the normal range. Statistical analysis revealed that acute appendicitis on gross examination and raised C-reactive protein had a statistically significant correlation with raised total leucocyte count (p-value: 0.001). Conclusion: Total leucocyte count was significantly raised in patients who had confirmation of inflammation of the appendix at gross examination during the surgery. Raised total leucocyte count and C reactive protein should be given more weightage in diagnosing acute appendicitis and planning for an emergency appendectomy.

Utilizing the MRI findings to diagnose acute appendicitis in pregnant women

Aims: To assess the performance of magnetic resonance ımaging (MRI ) scale for the diagnosis of acute appendicitis in pregnant women and to determine the added diagnostic value of MRI imaging.&#x0D; Methods: In this retrospective study, the data of patients who presented to our hospital emergency department between January 2018 and December 2021, had clinical and laboratory findings consistent with acute appendicitis, and were diagnosed with radiological imaging, were extracted from the hospital automation system and used for statistical analysis. Ultrasound (US) was used as the first-line diagnostic method for pregnant patients, and magnetic resonance imaging (MRI) was used as the second-line diagnostic method. The success of US and MRI examinations in diagnosing acute appendicitis was evaluated. In MRI examinations, the mean values of appendix diameter and wall thickness parameters were examined, and the sensitivity, specificity, positive predictive value, and negative predictive value of periappendiceal fat tissue intensity increase, T2A lumen hyperintensity, and periappendiceal fluid parameters were evaluated. Additionally, the frequency of acute appendicitis according to trimesters was examined. SPSS v20.0 (IBM SPSS Statistics for Windows, Version 20.0; Armonk, NY, USA) package program was used for the analysis.&#x0D; Results: When the medical records of 200 patients diagnosed with appandicitis were retrospectively examined, it was determined that there were 13 pregnant cases diagnosed with MRI during this period. Sensitivity, specificity, positive predictive value, and negative predictive value were evaluated for parameters including intraluminal T2A hyperintensity, wall thickness, periappendiceal fluid accumulation, and periappendiceal fatty tissue intensity increase. İntraluminal T2A hyperintensity and also periappendiceal fatty tissue intensity increase parameter sensitivity was 100%, however the wall thickness parameter had a sensitivity of 60% and the periappendiceal fluid accumulation parameter had a sensitivity of 80%. the periappendiceal fatty tissue intensity increase parameter had a a specificity of 33.3%, which is the lowest ratio among the other parameters. there was also no significant difference in the frequency of acute appendicitis according to trimesters &#x0D; Conclusion: MRI examination has a high success rate and can be used as the primary diagnostic method for pregnant appandicitis cases. In terms of parameter evaluation, the highest positive predictive value (90.9%) is found by the parameter of intraluminal T2 hyperintensity, and the parameter of periappendiceal fluid collection is found to be in the second place. The success of T2A lumen hyperintensity and periappendiceal fat tissue intensity increase parameters, especially in excluding negative cases, was found to be quite high.

The relationship between oral and dental health and appendicitis

Aims: In this study, we aimed to evaluate the relationship between the scores of the “Simplified Oral Hygiene Index” (OHI-S) indicating poor oral hygiene and the “Decayed, Missing and Filled Teeth” (DMFT) index indicating oral health impairment, and acute appendicitis (AA).&#x0D; Methods: Eighty four patients who were operated on with the diagnosis of acute appendicitis between April 2022 and May 2023 were included. The control group included 32 individuals without a history of appendectomy. In our study, oral health was evaluated using the DMFT and OHI-S indices. The DMFT index is one of the indices quantifying dental health status based on the number of cavities. OHI-S is an index used to evaluate oral hygiene.&#x0D; Results: The OHI-S index scores of the patients with AA were significantly higher than those of the control group (3.53±1.43, 2.56±1.24, p

WBC Count vs. CRP Level in Laboratory Markers and USG vs. CT Abdomen in Imaging Modalities: A Retrospective Study in the United Arab Emirates to Determine Which Are the Better Diagnostic Tools for Acute Appendicitis.

Introduction Acute Appendicitis (AA) is the most common surgical emergency. Despite the use of variousdiagnostic parameters, the rate of negative appendectomy remains high (30%). Thus, through our retrospective study, we aim to analyse whether white blood cell (WBC) count or C-reactive protein (CRP) level is more indicative in the confirmation of AA. We also analysed imaging modalities ultrasonography (USG) and computed tomography (CT) of the abdomen to find out which is better for diagnosing AA. Methods Patients with suspected AA admitted for laparoscopic appendectomy in Saqr Hospital, Ras Al Khaimah, United Arab Emirates, during 2019-2020 were included in the study. Patients who had either or bothWBC and CRP values were included in the study and their diagnosis was confirmed based on histological appendectomy findings. Data analysis was done using IBM SPSS Statistics for Windows, Version 23.0 (Released 2015; IBM Corp., Armonk, New York, United States), receiver operating characteristic (ROC) curve, and chi-square test as required. p-value of <0.05 was considered statistically significant. Results Out of the 320 patients with suspected AA, WBC had a p-value of 0.8 (insignificant). A total of 228 patients who had elevated WBChad confirmed histological diagnosis of AA, and 152 patients who were tested for CRP and had elevated levels had confirmed histological diagnosis of AA. CRP had a p-value of 0.04 (significant). However, when the ROC curve was used as evidence to see which was a better test, WBC and CRP both had a low area under the curve (AUC), which proved that they were not the most accurate diagnostic marker in diagnosing AA. However, CRP was slightly better than WBC. A total of 266 patients underwent USG abdomen and it had a p-value of 0.4 (insignificant), while 118 patients underwent CT scan, which had a p-value of0.01 (significant). CT abdomen was statistically proven as a better radiological investigation.Also, when the ROC curve was used to compare USG and CT abdomen, CT again proved to be a better radio diagnostic method for AA. Conclusions From our study, it can be concluded that CRP is better than WBC in ruling in appendicitis and CT abdomen is better than USG in diagnosing appendicitis, but CT abdomen is only next to histological diagnosis in confirming AA.Hence, we recommend doing CRP as the primary laboratory marker for suspected cases of AA.CT abdomen is the ideal imaging modality in cases of suspected AA where clinical examination, laboratory values, and ultrasound examination are inconclusive.

Disparities in Ultrasound Use for Diagnosing Pediatric Appendicitis Across United States Emergency Departments

IntroductionAn ultrasound (US)-first approach for evaluating appendicitis is recommended by the American College of Radiology. We sought to assess the access to and utilization of an US-first approach for children with acute appendicitis in United States Emergency Departments. MethodsUtilizing the 2019 Nationwide Emergency Department Sample, we performed a retrospective cohort study of patients <18 y with a primary diagnosis of acute appendicitis based on International Classification of Disease 10th Edition Diagnosis codes. Our primary outcome was the presentation to a hospital that does not perform US for children with acute appendicitis. Our secondary outcome was the receipt of a US at US-capable hospital. We developed generalized linear models with inverse-probability weighting to determine the association between patient characteristics and outcomes. ResultsOf 49,703 total children, 24,102 (48%) received a US evaluation. The odds of presenting at a hospital with no US use were significantly higher for patients aged 11-17 compared to patients <6 y (adjusted odds ratio [aOR] [95% confidence interval (CI)]: 1.59, [1.19- 2.13], P = 0.002); lowest median household income quartile compared to highest (aOR [95% CI]: 2.50, [1.52-4.10], P < 0.001); rural locations compared to metropolitan (aOR [95% CI]: 8.36 [5.54-12.6], P < 0.001), and Hispanic compared to non-Hispanic White (aOR [95% CI]: 0.63 [0.45-0.90], P = 0.01). The odds of receiving a US at US-capable hospitals were significantly lower for patients >6 y, lowest median household income quartiles, and rural locations (P < 0.05). ConclusionsRural, older, and poorer children are more likely to present to hospitals that do not utilize US in the diagnosis of acute appendicitis and are less likely to undergo US at US-capable hospitals.

A different way to diagnosis acute appendicitis: machine learning.

&lt;b&gt;&lt;br&gt;Indroduction:&lt;/b&gt; Machine learning is a branch of artificial intelligence based on the idea that systems can learn from data, identify patterns, and make decisions with minimal human intervention.&lt;/br&gt; &lt;b&gt;&lt;br&gt;Aim:&lt;/b&gt; Our aim is to predict acute appendicitis, which is the most common indication for emergency surgery, using machine learning algorithms with an easy and inexpensive method.&lt;/br&gt; &lt;b&gt;&lt;br&gt;Materials and methods:&lt;/b&gt; Patients who were treated surgically with a prediagnosis of acute appendicitis in a single center between 2011 and 2021 were analyzed. Patients with right lower quadrant pain were selected. A total of 189 positive and 156 negative appendectomies were found. Gender and hemogram were used as features. Machine learning algorithms and data analysis were made in Python (3.7) programming language.&lt;/br&gt; &lt;b&gt;&lt;br&gt;Results:&lt;/b&gt; Negative appendectomies were found in 62% (n = 97) of the women and in 38% (n = 59) of the men. Positive appendectomies were present in 38% (n = 72) of the women and 62% (n = 117) of the men. The accuracy in the test data was 82.7% in logistic regression, 68.9% in support vector machines, 78.1% in k-nearest neighbors, and 83.9% in neural networks. The accuracy in the voting classifier created with logistic regression, k-nearest neighbor, support vector machines, and artificial neural networks was 86.2%. In the voting classifier, the sensitivity was 83.7% and the specificity was 88.6%.&lt;/br&gt; &lt;b&gt;&lt;br&gt;Conclusions:&lt;/b&gt; The results of our study show that machine learning is an effective method for diagnosing acute appendicitis. This study presents a practical, easy, fast, and inexpensive method to predict the diagnosis of acute appendicitis.&lt;/br&gt.

A Comparison of the Modified Alvarado Score and the Raja Isteri Pengiran Anak Saleha Appendicitis (Ripasa) Score in a Southeast Asian Population With Histopathology as the Gold Standard.

Background The diagnosis of acute appendicitis has remained difficult despite it being one of the most common surgical emergencies in the world. One of the most frequently used scoring systems is the Modified Alvarado Score (MAS). However, the MAS has been known to be less efficient in Asian populations. To overcome this issue, the Raja Isteri Pengiran Anak Saleha Appendicitis (RIPASA) score has been specifically developed to improve the diagnosis of acute appendicitis in Asian populations. This study aimed to evaluate the accuracy of the RIPASA score compared to the MAS for the diagnosis of acute appendicitis in a Southeast Asian population keeping histopathology as the gold standard. Methodology The study group comprised 150 patients. Data were collected from each patient using a simple proforma to ascertain both the MAS and the RIPASA score for each patient at the time of presentation. The patients then underwent open appendectomy and histopathology was used as the gold standard to determine the presence or absence of acute appendicitis in the excised specimens. Results The RIPASA score had a sensitivity and specificity of 89.83% and 59.38%, respectively, compared to 64.41% and 53.12%, respectively, for the MAS. Diagnostic accuracy was similarly higher for the RIPASA score at 83.33% versus 62.00% for the MAS. Conclusions The RIPASA score is superior to the MAS for the diagnosis of acute appendicitis. Using the RIPASA score instead of the MAS in Southeast Asian populations can lead to a more accurate and timely clinical diagnosis of patients with suspected acute appendicitis and help improve patient outcomes.

Diagnostic Ultrasound for Acute Appendicitis: The Gold Standard

BackgroundAcute appendicitis may present a diagnostic dilemma. The aim of this study was to review the accuracy of ultrasound in the diagnosis of paediatric acute appendicitis. MethodUltrasound studies performed for investigation of appendicitis during 2015–2021 were retrieved from a tertiary paediatric hospital database and reviewed. Medical records were reviewed to determine operative intervention, further imaging, and final diagnosis. Diagnostic accuracy was assessed by sensitivity, specificity, predictivity, and overall accuracy. All appendicectomy specimens underwent histopathological confirmation. This study was approved by the local Human Research Ethics Committee. ResultsA total of 8555 consecutive ultrasound examinations were performed during the study period. Mean patient age was 10.8 years ( ± 3.7). Overall diagnostic accuracy was 96.1% (8221/8555) with a visualisation rate of 91.0%. Sensitivity and specificity were 96.2% (CI 95.3–97.0%) and 96.1% (CI 95.6–96.5%), respectively. When limited to positive/negative scans, sensitivity was 99.6% (CI 99.2–99.8%) and specificity 99.0% (CI 98.7–99.3%). Positive and negative predictive values were 96.9% and 99.9%, respectively. Repeat ultrasound following a non-diagnostic scan led to a definitive diagnosis in 76.1%. Negative appendicectomy rate was 5.5% overall in children who had undergone pre-operative ultrasound (107/1938), and 4.4% when other surgical pathologies were excluded. ConclusionUltrasound examination provides gold-standard accuracy in the diagnosis of paediatric appendicitis and reduces rates of negative appendicectomy. Given the disadvantages of computed tomography and magnetic resonance imaging, ultrasound should be considered the first-line investigation of choice in the diagnosis of acute appendicitis in children. Level of EvidenceIII.

The Accuracy of Abdominal Ultrasound and the Modified Alvarado Score in the Diagnosis of Acute Appendicitis

The Accuracy of Abdominal Ultrasound and the Modified Alvarado Score in the Diagnosis of Acute Appendicitis

Value of biochemical markers in the diagnosis and prediction of severity of acute appendicitis in children: a prospective randomized study

Background Appendectomy is one of the most commonly performed operations. Clinical evaluation of patients with acute appendicitis was the cardinal key point of diagnosis. Aim To evaluate the value of serum inflammatory markers in the diagnosis of acute appendicitis and suspicion of complication. Patients and methods This study was applied on children from 1 to 16 years old, who were diagnosed clinically as having acute appendicitis. Blood samples were collected from all patients for interleukin 6 (IL-6), C-reactive protein (CRP), white blood cells (WBC), and procalcitonin levels. Appendectomy was done for all patients, followed by histopathological examination for all specimens. The patients operated were classified according to the histopathological results. Results Over a span of the 12 months, 64 patients between 1 and 16 years old were operated for appendectomy and the positivity was confirmed by histopathology results. The positive group included 57 (89.1%) patients, while seven (10.9%) patients were included in the negative group. The 57 positive cases were subdivided into two groups: 33 (57.9%) cases had complicated appendicitis, while the other 24 (42.1%) cases had simple appendicitis. The values of biochemical markers: CRP, IL-6, procalcitonin, and WBCs, for all patients were assessed comparing the groups together. It was found that these markers were very significant in the differentiation of different groups. Conclusion Routine use of biochemical markers WBC, CRP, IL-6, and procalcitonin in children with suspected appendicitis is very helpful to increase the accuracy of diagnosis and to predict complication.

Risk of Conversion from Laparoscopic Appendectomy to Open Surgery: The Role of Clinical and Radiological Factors in Prediction.

Introduction: Laparoscopic appendectomy is the most preferred surgical method in the treatment of acute appendicitis. In our study, we aim to determine the clinical and radiological factors affecting conversion from laparoscopic appendectomy to open surgery. Materials and Methods: All patients older than 18 years, who were operated on with the diagnosis of acute appendicitis in the General Surgery clinic of Prof. Dr. İlhan Varank Training and Research hospital between January 2020 and January 2022, were included in the study. The data consisting of clinical, laboratory, and radiological (computed tomography) findings of the patients were evaluated retrospectively. The patients were divided into two groups as those whose surgery was completed laparoscopically (Group 1) and those converted from laparoscopic appendectomy to open surgery (Group 2). The risk of conversion to open surgery was analyzed by binary logistic regression analysis as univariate and multivariate models. Results: Appendectomy was performed in 831 patients within the specified period. The surgery of 31 (3.73%) patients started laparoscopically; however, they were completed by converting to open surgery. Multivariable analysis showed that the risk of conversion to open surgery increased with leukocyte count, Alvarado score and with the presence of periappendiceal fluid and lymphadenopathy on CT. Conclusion: Our study shows that patients with high risk of returning to open surgery can be identified preoperatively with the risk analysis method in which clinical, laboratory, and radiological findings are evaluated together. We conclude that, starting the operation of these patients with the open technique from the beginning will prevent unnecessary expenditures and reduce morbidities.

Accuracy of Neutrophil-to-Lymphocyte Ratio in Predicting the Severity of Acute Appendicitis: A Single-Center Retrospective Study.

Investigate the potential use of the neutrophil-to-lymphocyte ratio (NLR) in the identification and differentiation of acute appendicitis patients, specifically between simple and complicated presentations. An observational retrospective cohort study was conducted in Aseer Central Hospital, Saudi Arabia. In total, 103 patients were included in this study, in which males (50.5%) weremore common than females (49.5%), and the most common age group was found to be 36-45 years (56.3%), followed by 18-25 years (23.3%). All patients (100%) had a diagnosis of acute appendicitis. The means of neutrophils, lymphocytes, and NLR were found to be68.970%, 22.067%, and 5.020, respectively. The majority (69%) had non-complicated appendicitis, while (31%) had complications. A significant association was seen between NLR and the occurrence of complications (p-value = 0.00001). This study can comprehensively support the evidence presented in the literature review. The use of the NLR demonstrates a notable level of accuracy in diagnosing acute appendicitis and differentiating between complex and uncomplicated cases.

Appendicitis in pregnant women: A systematic review and meta-analysis of the diagnostic performance of ultrasonography.

The accuracy of ultrasound in the detection of appendicitis in pregnant women was examined in a meta-analysis. Pregnant women with suspected acute appendicitis were evaluated using ultrasound in a systematic search of PubMed, EMBASE, and Cochrane Library databases from January 1, 2011 to August 10, 2023. The sensitivity and specificity values and diagnostic odds ratios were obtained using the pooled data. A total of 239 patients were studied in four relevant investigations. Ultrasonography has a sensitivity of 56% and a specificity of 88% for the diagnosis of acute appendicitis, with an area under the receiver operating characteristic curve of 0.66%. Ultrasonography had a positive likelihood ratio of 4.65 (95% confidence interval, 1.42-15.23) and a negative likelihood ratio of 0.50 (95% confidence interval, 0.41-0.62). There was no evidence of publication bias (p = 0.93). Ultrasound has moderate sensitivity for identifying appendicitis in pregnant women and may be utilized as an alternative diagnostic method.

Comparison of Pediatric Acute Appendicitis Before and During the COVID-19 Pandemic in New York City.

Background: Acute appendicitis (AA) is the most common abdominal surgical emergency in children and adolescents. In the year immediately following the declaration of the coronavirus disease 2019 (COVID-19) pandemic by the World Health Organization (WHO), there was a precipitous decline in emergency department (ED) visits especially for surgical conditions and infectious diseases. Fear of exposure to severe acute respiratory coronavirus 2 infection resulted in delay in presentation and time to surgery, and a shift toward more conservative management. Objective: Our goal was to compare the incidence and severity of AA before and during the COVID-19 pandemic. Methods: Patients aged 2-18years admitted with the diagnosis of AA to Flushing Hospital Medical Center or Jamaica Hospital Medical Center in Queens, New York, were selected for chart review. Data extracted from electronic health records included demographics, clinical findings, imaging studies, and operative and pathological findings. We calculated the Alvarado score (AS) for incidence and the American Association for the Surgery of Trauma (AAST) grade for severity. We compared patients admitted between March 1, 2018-February 29, 2020 (pre-pandemic) to patients admitted between March 1, 2020-February 28, 2021 (pandemic). We then compared pre-pandemic and pandemic groups to determine differences in pediatric AA incidence and severity. Results: Of 239 patients diagnosed with AA, 184 (77%) were in the pre-pandemic group and 55 (23%) in the pandemic group. Incidence (number per year) of AA declined by 40%. The pandemic group had significantly greater overall AS of ≥7, indicating increased likelihood to require surgery, (P = 0.04) and higher AAST grade demonstrating increased severity (P = 0.02). Conclusion: There was a decline in the number of AA cases seen in our pediatric EDs and admitted during the first year of the pandemic. Clinicians need to be aware of increased severity of AA at time of presentation during public health emergencies such as a pandemic, possibly due to modified patient behavior.