Periappendicular Abscess Research Articles

Efficacy of Amikacin and Ceftriaxone in the empiric antibacterial therapy of friable appendicular infiltrate and periappendicular abscess at different age groups

Introduction. In the structure of acute pathology in the abdominal cavity of children associated with appendicular peritonitis, local limited forms occur in 10–16.8% of cases, mainly in older patients.Purpose. To make a comparative assessment of Amikacin and Ceftriaxone efficacy in the empiric antibacterial therapy of appendicular infiltrate and periappendicular abscess in children of different age groups under the dynamics of inflammatory process and results of bacteriological tests.Material and methods. The article provides a retrospective analysis of 43 medical records of children of various ages with appendicular infiltrate and periappendicular abscess. All patients had a quantitative assessment of inflammatory markers and bacteriological findings in their gastric content. Amikacin and Ceftriaxone were prescribed as a starting antibacterial therapy.Results. The present trail revealed a rather high incidence of appendicular infiltrate and periappendicular abscess in children. The maximum increase in leukocytes number, C-reactive protein were registered before surgery and one day after it, mostly in little children. The acid α1-glycoprotein level was increasing during the first day after surgery in little patients, while in adolescents and teenagers it didn’t change significantly.Bacteriological examination of the gastric content revealed that the most common pathogens were Escherichia coli (34.9%) and Pseudomonas aeruginosa (14%). Many pathogenic bacteria were highly sensitive to Amikacin and little sensitive to Ceftriaxone. In two children, lack of sensitivity of microorganisms to antibacterial drugs caused the development of abdominal abscesses in the postoperative period.Conclusion. The empiric antibiotic therapy is of great importance in the management of appendicular infiltrate and periappendicular abscess. While prescribing the starting antibiotic therapy, a physician has to use his/her experience and to know or to anticipate possible microflora nature and its sensitivity to antimicrobial preparations.

Differential approach to the diagnosis and treatment of appendicular peritonitis in children

The incidence of appendicular peritonitis (AP) is 3-4 % among all acute surgical diseases in children, and the structure of acute appendicitis in recent decades fluctuates within 10-15 %. Timeliness and informativeness of acute abdomen diagnostics remain important tasks of clinical practice. The use of laparoscopy with its possibility of diapeutic approach allows to diagnose and eliminate the cause of the disease. On the basis of the surgical department of the Children's City Clinical Hospital No. 1 in Nizhny Novgorod. In the period from 2018 to 2022, 126 (11.2%) patients with various types of AP were treated in Nizhny Novgorod. All children were examined with assessment of general and local status, laboratory tests were performed using unified methods developed for practical healthcare. In complicated or doubtful cases, ultrasound of the abdominal cavity organs was performed (Vivid-7 of expert class using high-frequency transducers: convex (frequency up to 5 MHz) and linear (frequency up to 10 MHz). Local forms of AP prevailed – 90 %, of which appendicular abscess was found in 35 % of observations. Data of anamnesis, examination of patients, assessment of purulent-inflammatory markers in complicated and controversial situations were resolved by ultrasound of abdominal cavity organs. Instrumental diagnostics allowed them to detect anechogenic contents (effusion), delimited areas of absceding between the intestinal loops, perforation defect of the appendix wall, periappendicular abscess forming. Within the framework of surgical correction the priority was given to laparoscopy (59.5 %), a modern therapeutic and diagnostic method with a diapeutic approach. Open interventions were used in 51 (49.5%) patients, of which: Sprengel's access was performed in 31 (61%) patients, Volkovich-Dyakonov was used in 19 (37%) cases, midline laparotomy was performed in 1 child. Analysis of the results of bacteriological studies allowed us to identify the leading pathological pathogens belonging to Gram-negative or Gram-positive flora. In the postoperative period, therapy corresponding to the treatment of patients with peritonitis was prescribed. Evaluation of bacteriological examination revealed that Enterobacteriaceae (87%), non-fermenting bacteria (72%) were susceptible to all antibiotics. However, the highest susceptibility (73 %) was noted to cephalosporins. All children were discharged home in satisfactory condition, with an average bed-day of 12.32 ± 2.4.

Higher Rates of Complicated Appendicitis During the COVID-19 Pandemic: A Year-to-Year Analysis

IntroductionThe COVID-19 pandemic impacted presentation, management strategies, and patient outcomes of numerous medical conditions. The aim of this study is to perform a year-to-year comparison of clinical outcomes of patients with acute appendicitis (AA) before and during the pandemic. MethodsPatients treated for AA during the initial 12-mo period of the pandemic at our institute were compared to those treated for AA during the 12-mo period before. Clinical and laboratory parameters, treatment strategies, intraoperative findings, pathology reports, and postoperative outcomes were compared. ResultsDuring the study period, 541 patients presented with AA. The median (interquartile range) age was 28 (21-40) y and 292 (54%) were males. 262 (48%) patients presented during the pre-COVID-19 period, while 279 patients (52%) presented during the COVID 19 pandemic. The groups were comparable for baseline clinical data and imaging results upon index admission. There was no significant difference in rate of nonoperative treatment between the Pre-COVID-19 and During-COVID-19 eras (51% versus 53%, P = 0.6) as well as the success rate of such treatment (95.4% versus 96.4%, P = 0.3). Significantly more patients presented with a periappendicular abscess during COVID-19 (4.6% versus 1.1%, P = 0.01) and median (interquartile range) operative time was significantly longer (78 (61-90) versus 32.5 (27-45) min, P < 0.001). Pathology reports revealed a higher rate of perforated appendicitis during COVID-19 (27.4% versus 10.2%, P < 0.001). ConclusionsPatients with AA present with higher rates of perforated and complicated appendicitis during the COVID-19 pandemic. The success rates of nonoperative management in selected patients with noncomplicated AA did not change during the pandemic and is a safe, feasible, option.

Post-Operative Outcomes of Laparoscopic Appendectomy in Acute Complicated Appendicitis: A Single Center Study.

Acute appendicitis (AA) is a surgical emergency because of inflammation in the appendix leading to swelling, whereas acute complicated appendicitis is characterized by a gangrenous or perforated appendix with or without periappendicular abscess, peritonitis, and an appendicular mass. The laparoscopic approach in complicated acute appendicitis is a viable alternative method but is not practiced in all cases because of technical difficulties and unpredictable complications. Thus, the present study aimed to evaluate the primary and secondary outcome predictors of laparoscopic appendectomy in complicated appendicitis. A single-center prospective observational study was carried out after the approval of the Institutional Ethics Committee (IEC). A total of 87 complicated acute appendicitis patients were included in the study. Clinico-demographic features such as age, gender, duration of surgery, post-operative pain, and hospital stay were monitored in different age groups of <20, 20-39, and >40 years, and the primary and secondary outcomes of laparoscopic surgery in acute complicated appendicitis were measured. Acute complicated appendicitis cases were observed mostly in people older than 42 years in the total study population. Laparoscopic appendectomy was conducted in all 87 acute complicated appendicitis patients, and the major surgical outcome predictors were monitored, such as mean operating time (87.9 minutes), post-operative pain (3.9 scores), and post-operative stay (6.7 days). Post-operative complications such as drain site infection (1.14%), enterocutaneous fistula (2%), and intra-abdominal abscess (7%) were observed. Based on our observations, a laparoscopic appendectomy can be considered a viable alternative with an acceptable complication rate. Operative time varies from 84 to 94 minutes in different age groups and with the extent of the disease.

The efficacy of hemoglobin, albumin, lymphocytes, and platelets (HALP) score in signifying acute appendicitis severity and postoperative outcomes.

The HALP score, which is a combined index composed of hemoglobin, albumin, lymphocyte, and platelet, is a new indicator showing both inflammation and nutritional status. This study aims to evaluate the relationship of this combined index consisting of simple laboratory values with the degree of appendicitis complication and postoperative results in patients operated on for acute appendicitis. The data of 684 patients operated for acute appendicitis between January 2017 and December 2022 and inclusion criteria were analyzed with a single-center retrospective cross-sectional study design. Using routine laboratory data, patients' HALP scores were divided into two groups as low and high. The cut-off value of the HALP score according to the presence of postoperative complications was determined as < 31.2 by ROC analysis and the ROC curve. Patients were grouped as HALP score cut-off value below (group 1) and above (group 2). Complicated appendicitis and postoperative outcomes were compared to the HALP score groups. According to the cut-off value of the HALP score, 113 (16.5%) of the patients were in Group 1, and 571 (83.5%) were in Group 2. Complications developed in 15 (26%) patients (p < 0.001). Low HALP scores were a significant risk factor for peri-appendicular abscess (OR 29.12 95% CI 12.39-68.43), appendicitis perforation (OR = 20.82 95% 12.67-34.19), gangrenous appendicitis (OR = 35, 54, 95% 13.33-94.77), and postoperative complications (OR = 15.29 95% 7.95-29.41) (p < 0.001). Besides clinical and radiological findings, the HALP score shows the degree of acute appendicitis complication. It can be used as a simple, inexpensive, and easily applicable diagnostic tool.

The Emergency Surgery Frailty Index (EmSFI) in Elderly Patients with Acute Appendicitis: An External Validation of Prognostic Score

BackgroundIdentification of reliable risk-stratification tools is critical for surgical decision making, particularly in frail and elderly. The aim of the study is to validate the Emergency Surgery Frailty Index (EmSFI), in over 65 years old patients operated on for acute appendicitis.MethodsAn observational study was conducted enrolling elderly patients with diagnosis of acute appendicitis who underwent emergency appendicectomy or right colectomy, between 2016 and 2021. All patients were treated according to the last SIFIPAC/WSES/SICG/SIMEU guidelines.ResultsOverall, 61 patients were analyzed. Complication rate was higher for patients in the second EmSFI risk Class. Moreover, ROC analyses identified 3 as the best cutoff value in predicting risk of adverse postoperative events. Complication rate was higher in oldest elderly patients—over 80 years—(42.9 vs 22.5%; p 0.05) and was mainly related to medical complications (42.9 vs 12.5%, p 0.007). However, intestinal obstruction, peri-appendicular abscess on preoperative CT, peritonitis and a longer duration of surgery are related with increased risk of complications in the group of patients under 80 years.ConclusionThe EmSFI score results a valid prognostic marker for frailty status, and it may support the surgeon in emergency setting for acute appendicitis. Patients aged 80 years or older have a higher risk of complications, independent from those factors which relate to increased morbidity in younger elderly patients. Age alone is not a reliable indicator of the real surgical risk, but it must encourage the adoption of multidisciplinary collaborative models of care for this group of patients.

Retrospective cohort study of the impact of faecoliths on the natural history of acute appendicitis

BackgroundDespite acute appendicitis is one of the most common surgical emergencies, its aetiology remains incompletely understood.AimThis study aimed to assess the rate at which faecoliths were present in acute appendicitis treated with appendicectomy and whether their presence was associated with complicated appendicitis.MethodsAll adult patients who underwent appendicectomy for acute appendicitis in a 2 years period (January 2018 and December 2019) at a single institution were retrospectively reviewed. The presence of a faecolith was identified by at least one of three methods: pre-operative CT scan, intraoperative identification, or histopathology report. Patients were grouped according to the presence or absence of a faecolith and demographics, type of appendicitis and surgical outcomes analysed. Complicated appendicitis was defined as appendicitis with perforation, gangrene and/or periappendicular abscess formation.ResultsA total of 1035 appendicectomies were performed with acute appendicitis confirmed in 860 (83%), of which 314 (37%) were classified as complicated appendicitis. Three hundred thirty-nine (35%) of the appendicitis cases had faecoliths (complicated 165/314 cases; 53%; uncomplicated 128/546; 23%, p < 0.001). The presence of a faecolith was associated with higher complications and a subsequent longer post-operative stay.ConclusionThe rigorous methodology of this study has demonstrated a higher rate of faecolith presence in acute appendicitis than previously documented. It reinforces the association of faecoliths with a complicated disease course and the importance in prioritising emergency surgery and postoperative monitoring for complications.

Acute appendicitis manifests as two microbiome state types with oral pathogens influencing severity

ABSTRACT Mounting evidence suggests that acute appendicitis (AA) is not one but two diseases: complicated appendicitis, which is associated with necrosis leading to perforation or periappendicular abscess, and uncomplicated appendicitis, which does not necessarily result in perforation. Even though AA is the most frequent cause of surgery from abdominal pain, little is known about the origins and etiopathogenesis of this disease, much less regarding the different disease types. In this study, we investigated the microbiome (inter-domain amplicon and metagenome sequencing) of samples from the appendix, rectum and peritoneum of 60 children and adolescents with AA to assess the composition and potential function of bacteria, archaea and fungi. The analysis of the appendix microbial community revealed a shift depending on the severity of the AA. This shift was reflected by two major community state types that represented the complicated and uncomplicated cases. We could demonstrate that complicated, but not uncomplicated, appendicitis is associated with a significant local expansion of oral, bacterial pathogens in the appendix, most strongly influenced by necrotizing Fusobacterium spp., Porphyromonas and Parvimonas. Uncomplicated appendicitis, however, was characterized by gut-associated microbiomes. Our findings support the hypothesis that two disease types exist in AA, which cannot be distinguished beyond doubt using standard clinical characterization methods or by analysis of the patient’s rectal microbiome. An advanced microbiome diagnosis, however, could improve non-surgical treatment of uncomplicated AA.

Апендикулярно-генітальний синдром у дітей

The importance of preserving the reproductive potential of the population of Ukraine is due to the increase in the number of women with infertility due to infectious and inflammatory diseases of the abdominal cavity and pelvic organs, which were suffered in childhood and adolescence. Purpose - to determine and systemize of the most significant factors of appendicular-genital syndrome depending on the primary pathological focus; to develop a practically significant classification signs and an algorithm for examination and treatment of girls with combined pathology to improve the results of treatment of this group of patients. Materials and methods. It was carried out an analysis of the medical records of inpatients, girls, for the period from October 2019 to May 2022, who were hospitalized for urgent indications and operated on for acute surgical pathology of the organs of the abdominal cavity and pelvis of an inflammatory nature. The age of the patients ranged from 4 to 17 years old (average age 11.0+0.5 years old). In the process of preliminary analysis, it was found that out of 203 patients who were to be treated surgically for the clinical picture of «acute abdomen», combined appendicular-genital pathology occurred in 13 girls. Results. It was determined that the key feature of appendicular-genital syndrome is the non-specificity of the clinical picture. In the appendicular form of the disease, the symptoms of acute appendicitis predominate in the pathological state, and in the genital form, the symptoms of acute adnexitis dominate. Connective appendicular-genital pathology in the catarrhal form of inflammation of the appendix was determined in 2 (15.39%) cases, in the phlegmonous form in 8 (61.54%) cases, in the gangrenous form in 2 (15.39%) cases, in periappendicular abscess - in 1 (7.68%) case. All patients in the study group underwent surgical treatment, the extent of which in each case was determined by the surgical findings and the prevalence of the pathological process. Most (61.58%) surgical interventions were performed laparoscopically, in compliance with the principles of maximally organ-preserving techniques (appendectomy, organ detorsion, stopping bleeding, excision of cysts, sanitation of the abdominal cavity, and, if necessary, drainage of the pelvic cavity). Only in 2 (15.38%) cases was the removal of the uterine appendages during their torsion, under the conditions of their obvious necrosis and the duration of the disease more than 72 hours. Conclusions. In order to improve the quality and speed of diagnosis of the combined inflammation of the appendix and uterine appendages, as structural elements of the syndrome «acute abdomen», the preoperative examination of patients should be multidisciplinary and necessarily include an examination by a pediatric surgeon, a pediatric gynecologist, and a pediatrician, with ultrasound of the abdominal cavity, pelvis, and retroperitoneal space. Frequency occurrence of appendicular-genital syndrome in girls is on average 6.4% of the total number of patients with the syndrome «acute abdomen». During the surgical remediation of the primary focus of inflammation relative to the appendages of the uterus, the tactics should be as organ-sparing as possible with extensive use of laparoscopic techniques for mandatory visual assessment of the organs of the abdominal cavity and pelvis. Patients who underwent surgical treatment for acute appendicitis in combination with diseases of the uterine appendages should form a separate dispensary group, in which preventive examinations are recommended once every 3 months during the first postoperative year, and thereafter once every 6 months until the moment of patient’s transfer to an adult medical and preventive institution. The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of the participating institution. The informed consent of the patient was obtained for conducting the studies. No conflict of interests was declared by the authors.

Prevention of radiation enteritis by interposition of an intra-abdominal spacer before irradiation of an appendiceal tumour abscess drainage route.

The initial presentation of a mucinous adenocarcinoma of the appendix can be a peri-appendicular abscess. The abdominal wall muscles can be invaded during radiological or surgical drainage. The management of such a tumour is complex. The resection of a drainage route can be uncertain and R1. In this case, further treatment with adjuvant radiotherapy may be necessary. One possible deleterious side effect of radiotherapy on the abdominal wall is radiation injury to the bowel. As a preventive measure, a spacer (here a breast prosthesis) can be interposed.

Characteristics of Patients Presented with Complicated Appendicitis in Adama, Ethiopia: A Cross-Sectional Study.

BackgroundComplicated appendicitis (CA) is defined as perforated appendicitis, peritonitis, peri-appendicular abscess, or appendicular mass. One-third of patients who develop appendicitis are diagnosed with CA at presentation. Studies regarding the prevalence of CA are lacking in low-income countries, and the characteristics of patients presented with CA are incoherently identified.ObjectiveTo assess the prevalence and the significant characteristics associated with CA among patients admitted with the diagnosis of acute appendicitis at Adama Hospital Medical College.MethodsA cross-sectional study was conducted from January 1, 2018, up to December 31, 2019. From a total of 1043 patients during the study period, the charts of 431 patients were selected using a systematic random sampling technique. Data were collected by a structured checklist. Bivariate and multivariable binary logistic regression analyses were employed to assess the association of patients’ characteristics with CA.ResultsOut of 431 patients, 157 (36.4%) had CA. Characteristics of patients having a significant association with CA were found to be generalized abdominal tenderness (AOR: 27.48, 95% CI: 4.03, 187.24), diagnosis with peritonitis (AOR: 14.87, 95% CI: 4.05, 54.54), right lower quadrant (RLQ) abdominal mass (AOR: 7.79, 95% CI: 2.02, 29.99), shock (10.37, 95% CI: 3.18, 33.76), white blood cell (WBC) count >11,000 (AOR: 2.16, 95% CI: 1.02, 4.61), onset to visit interval of 8–14 days (AOR: 10.45, 95% CI: 2.4, 45.52) and ultrasound report of acute appendicitis (AOR: 0.33, 95% CI: 0.13, 0.85), appendiceal abscess (AOR: 5.05, 95% CI: 1.48, 17.31), and appendiceal mass (AOR: 6.04, 95% CI: 1.45, 25.14).ConclusionThe prevalence of CA was very high. Generalized abdominal tenderness, RLQ abdominal mass, shock, WBC count, onset to visit interval, abdominopelvic ultrasound report, and clinical diagnosis of peritonitis were significantly associated with CA.

A Rare Complication of Perforated Appendicitis: A Case of Necrotizing Fasciitis

Acute appendicitis is considered one of the most common surgical emergencies with low morbidity and mortality. However, delay in the diagnosis may lead to perforation of the appendix. Hence, complications may arise, including necrotizing fasciitis, a rare complication of a perforated appendix. We present a case of perforated appendicitis complicated by necrotizing fasciitis leading to rapid deterioration.A 75-year-old male patient presented to our emergency room with a three-day history of right lower quadrant abdominal pain and abdominal distention. On admission, computed tomography (CT) scan showed a perforated appendix and peri-appendicular abscess. An exploratory laparotomy was performed. The appendix was resected and the wound closed. The patient was recovering well and tolerating food after the procedure. However, the patient developed progressive erythema/swelling over the right flank with new-onset leukocytosis. The diagnosis of necrotizing fasciitis was suspected and confirmed by careful evaluation and laboratory/radiological tests. Antibiotics were changed to clindamycin and piperacillin/tazobactam, and the patient was taken back to the operation room (OR) for surgical debridement. Postoperatively, the patient was shifted to the intensive care unit (ICU). He developed hearing impairment, which improved after the cessation of clindamycin. He was discharged in good condition after three weeks of hospital stay.This case report highlights the importance of maintaining a high index of suspicion for necrotizing soft tissue infection in immunocompromised patients with perforated appendicitis and being cautious when prescribing clindamycin to patients at risk of hearing loss.

Acute appendicitis in pregnancy; A single center experience

Objective&#x0D; Appendicitis is the most common cause of extrauterine acute abdomen during pregnancy. There are scoring systems, such as Alvarado, based on physical examination and laboratory values developed for the diagnosis of appendicitis in the general population. However, when it comes to pregnant women, the effectiveness of the methods used in daily practice decreases considerably. In our study, we aimed to share the data of our patients who were diagnosed with acute appendicitis during pregnancy in our clinic.&#x0D; Material methods&#x0D; Pregnant women who were operated for acute appendicitis between April 2008 and May 2021 were included in the study. Demographic data of the patients, gestational week, physical examination and laboratory values at the time of admission, USG findings, type of surgery performed, surgical findings, pathology results and fetal-maternal complications that developed during postoperative follow -up were reviewed retrospectively through the hospital system.&#x0D; Results &#x0D; From the clinicopathological features of the patients, only re-operation due to appendiceal stump leakage (p:0.04) and drain placement during operation (p:0.046) were significantly associated with miscarriage. Although complications and abortion rates were higher in patients with perforation and periappendicular abscess, the difference was not statistically significant.&#x0D; Conclusion&#x0D; Detailed history and physical examination are key for the diagnosis of acute appendicitis in pregnant women. Any patient with right lower quadrant pain, nausea, vomiting and fever, who has tenderness and defensive rebound in the right lower quadrant on physical examination should be considered as appendicitis after obstetric causes are excluded, until proven otherwise.

НОВЫЕ ПОДХОДЫ В ЛЕЧЕНИИ ПАЦИЕНТОВ С ОСЛОЖНЕННЫМ ДЕСТРУКТИВНЫМ АППЕНДИЦИТОМ

Abstract. Introduction. The treatment of complicated forms of acute destructive appendicitis remains an urgent problem of urgent abdominal surgery. Aim. The aim of our investigation was to substantiate the use of VAC-therapy to improve the results of surgical treatment of patients with acute destructive appendicitis complicated by typhlitis and periappendicular abscess. Material and methods. The present investigation is based on the results analysis of 84 patients aged from 17 to 78 years with acute destructive appendicitis, complicated by typhlitis and periappendicular abscess, being treated at the department of surgery 2 of the State Medical Institution City Clinical Hospital 7 of Kazan. Open ligature appendectomy was performed in all cases due to pronounced infiltration of the cecum dome. Two groups of patients were singled out according to the method of ОБМЕН ОПЫТОМ ВЕСТНИК СОВРЕМЕННОЙ КЛИНИЧЕСКОЙ МЕДИЦИНЫ 2021 Том 15, вып. 2ВЕСТНИК СОВРЕМЕННОЙ КЛИНИЧЕСКОЙ МЕДИЦИНЫ 2022 Том 15, вып. 4110 surgical intervention completion. In 54 patients of the comparison group the surgical intervention was terminated by gauze- gingival drainage of the appendix bed, since there was a high probability of appendix residual limb failure and necessity of purulent process isolation from the free abdominal cavity. Penrose drainage was removed through the surgical wound. In addition, the pelvis was drained through the contraperitoneum with a tubular drain. In 30 patients of the main group after appendectomy for abdominal cavity drainage we connected a Vacuum–assisted closure-system using Vivano apparatus and consumables of Hartman, Germany. Statistical processing of the results was carried out using Statistiсa 10 software package and Miсrosoft Exсel 2010. The differences were considered statistically significant at p&lt;0.05. Results and discussion. Analysis of the used surgical techniques showed that in the main group the wound postoperative complications decreased by 3 times and were 23,3%; formation of the abdominal cavity infiltrates was 2 times less; period of hospitalization decreased by 1,8 times. Conclusion. Ease of implementation of VAC-therapy method, therapeutic and economic feasibility allow us to recommend it as the final stage of treatment of acute destructive appendicitis complicated by typhlitis and periappendicular abscess

Suspected and Confirmed Acute Appendicitis During the COVID-19 Pandemic: First and Second Quarantines-a Prospective Study.

PurposeCOVID-19 posed an unprecedented modern global healthcare crisis affecting both elective and urgent surgeries. The aim of this study is to evaluate the difference in the presentation of acute appendicitis (AA) before and during the COVID-19 era, the first and second quarantines.MethodsWe performed a prospective study from December 2018 to May 2021. Two cohorts were analysed, one with patients who presented to the emergency department (ED) with suspected AA and the second with confirmed AA. Both cohorts were divided into four groups: before COVID-19, during the first quarantine, between the first and second quarantine, and during the second quarantine. Data such as demographics, the time to first contact with the healthcare provider and time to operation, laboratory tests, clinical stage of AA, length of stay, and COVID-19 status were collected. A total of 469 patients were enrolled.ResultsA total of 209 patients were male (45%) and 260 were female (55%), with the median age being 33 years (24–45). In the first cohort of suspected AA, there was no difference in sex; however, more older patients presented to the ED during the first quarantine (41 years) compared with other groups (28.5, 36, and 32.5 years), p < 0.000. Before the pandemic, there was a shorter duration of symptoms to first contact with the healthcare provider (13 h) compared with other groups, p = 0.001. In the second cohort of confirmed AA, there was a shorter period of time to operation from first symptoms before the pandemic (22 h) compared with other groups (30, 35, 30.5 h), p < 0.000. There were more complicated gangrenous, perforated appendicitis or periappendicular abscess in Group 2 and 3 (26, 22 and 10%, and 26, 22 and 2%, respectively) compared with Group 1 (20, 4 and 3%) and Group 4 (22, 12, and 2%), p = 0.009. Hospital stay was longer during the first quarantine (3 days) compared with other groups (2 days), p = 0.009. Six patients were COVID-19 positive: one from Group 3 and five from Group 4 (p > 0.05).ConclusionsOur study suggests that during the first quarantine of the COVID-19 pandemic, there was delayed presentation to the ED with suspected AA and there was a greater proportion of complicated appendicitis and longer hospitalization in confirmed cases as well.

Discitis due to late-onset mesh infection 14 years after inguinal hernia repair: a case report

BackgroundMesh infection after inguinal hernia repair is a very rare complication. The incidence of late-onset mesh infection is approximately 0.1–0.2% of total hernia repair cases and can lead to serious complications if not treated promptly. Here, we report a rare case of discitis due to late-onset mesh infection, occurring 14 years after an inguinal hernia repair.Case presentationAn 89-year-old man was brought to our hospital with right-sided abdominal pain and signs of hypoglycemia. He had a history of type 2 diabetes mellitus and had undergone inguinal hernia repair 14 years ago. Upon admission, laboratory tests revealed no elevated inflammatory markers. Computed tomography (CT) revealed a peri-appendicular abscess. Although the patient was administered empiric antibiotics, on day 3 of admission, his white blood cell count and C-reactive protein levels increased to 38,000/µl and 28 mg/dl, respectively. CT-guided drainage was attempted but was not successful. Escherichia coli was detected in both blood culture collections. On day 7 of admission, the patient complained of back pain; CT on day 10 revealed a peri-appendicular abscess with a soft tissue shadow anterior to the thoracic vertebrae at the 8th/9th level. Thoracic discitis, due to bacteremia originating from the mesh abscess, was suspected. We surgically resected the appendix, followed by removal of the plug and mesh abscess. The post-operative course of the patient was uneventful. For treating discitis, it is known that antibiotic therapy is required for a minimum of 6 weeks. Therefore, on the 30th day post-surgery, the patient was transferred to the orthopedic ward for continued treatment.ConclusionsThis report discusses a rare case of late-onset mesh infection leading to thoracic discitis. Since late-onset mesh infection cannot be treated solely with antibiotics, expeditious surgery should be selected when subcutaneous drainage fails. When an immunocompromised patient with bacteremia has a complaint of back pain, purulent spinal discitis should also be suspected.

Did the COVID-19 Pandemic Affect the Management of Patients With Acute Appendicitis?

BackgroundThe coronavirus disease 2019 (COVID-19) pandemic has changed the lives and habits of people all over the world. In this study, it was planned to investigate the effect of the COVID-19 pandemic on the diagnosis and treatment duration of acute appendicitis (AA), morbidity and mortality.MethodsThe data of patients who were operated on with the diagnosis of AA in our clinic between March 2019 and March 2021, divided into pre-COVID and post-COVID periods, were analyzed. Patients diagnosed with AA, who had the only appendectomy perioperatively, and who had complete preoperative blood analysis and radiological imaging data were included in the study.ResultsThe time from the onset of symptoms to the time of admission to the hospital was statistically significantly longer than in the post-COVID group (p=0.04). During the COVID-19 pandemic period, the use of ultrasonography was statistically significantly reduced (p<0.01); computed tomography use increased (p<0.001). Laparoscopic appendectomy as a surgical technique decreased statistically significantly during the pandemic period (p=0.02). Postoperative complications and the postoperative complication severity degrees were not statistically significant between periods (p=0.24, p=0.68). The risk for the occurrence of postoperative complications in COVID-19 positive patients was statistically higher (p=0.01) (OR: 9.38 95% CI: 1.96 - 44.88).ConclusionThe COVID-19 pandemic had caused delays in the admission and diagnosis of patients who might need surgery due to AA. Postoperative complication frequency and complication severity classification were not affected. COVID-19 positivity was a risk factor for complex AA presenting with periappendicular abscess, gangrenous and perforated appendix.

The association between appendicitis severity and patient age with appendiceal neoplasm histology—a population-based study

PurposeRecent studies have reported alarming appendiceal tumor rates associated with complicated acute appendicitis, especially in patients presenting with a periappendicular abscess. However, the data on histology of appendiceal tumors among acute appendicitis patients is limited, especially in patient cohorts differentiating between uncomplicated and complicated acute appendicitis. We have previously reported the association of increased appendiceal tumor prevalence with complicated acute appendicitis in this population-based study. The objective of this secondary analysis was to evaluate the association of both appendicitis severity and patient age with appendiceal tumor histology.MethodsThis nationwide population-based registry study (The Finnish Cancer Registry) was conducted from 2007 to 2013. All appendiceal tumors (n = 840) and available medical reports (n = 504) of these patients at eight study hospitals were previously evaluated, identifying altogether 250 patients with both acute appendicitis and appendiceal tumor.ResultsThe severity of acute appendicitis was significantly associated with more malignant tumor histology. The risk of adenocarcinoma or pseudomyxoma was significantly higher among patients with periappendicular abscess (OR 15.05, CI 95% 6.98–32.49, p < 0.001) and patients presenting with perforated acute appendicitis (OR 4.09, CI 95% 1.69–9.90, p = 0.0018) compared to patients with uncomplicated acute appendicitis. Similarly, patient age over 40 years was significantly associated with the risk of adenocarcinoma and pseudomyxoma (OR 26.46, Cl 95% 7.95–88.09, p < 0.001). Patient sex was not associated with a more malignant appendiceal tumor histology (p = 0.67).ConclusionMore malignant appendiceal tumor histology of adenocarcinoma or pseudomyxoma was significantly associated with patient age over 40 years and complicated acute appendicitis, especially periappendicular abscess.

Delayed diagnosis and subsequently increased severity of acute appendicitis (compatible with clinical-pathologic grounds) during the COVID-19 pandemic: an observational case-control study

BackgroundDuring a global crisis like the current COVID-19 pandemic, delayed admission to hospital in cases of emergent medical illness may lead to serious adverse consequences. We aimed to determine whether such delayed admission affected the severity of an inflammatory process regarding acute appendicitis, and its convalescence.MethodsIn a retrospective observational cohort case-control study, we analyzed the medical data of 60 patients who were emergently and consecutively admitted to our hospital due to acute appendicitis as established by clinical presentation and imaging modalities, during the period of the COVID-19 pandemic (our study group). We matched a statistically control group consisting of 97 patients who were admitted during a previous 12-month period for the same etiology. All underwent laparoscopic appendectomy. The main study parameters included intraoperative findings (validated by histopathology), duration of abdominal pain prior to admission, hospital stay and postoperative convalescence (reflecting the consequences of delay in diagnosis and surgery).ResultsThe mean duration of abdominal pain until surgery was significantly longer in the study group. The rate of advanced appendicitis (suppurative and gangrenous appendicitis as well as peri-appendicular abscess) was greater in the study than in the control group (38.3 vs. 21.6%, 23.3 vs. 16.5%, and 5 vs. 1% respectively), as well as mean hospital stay.ConclusionsA global crisis like the current viral pandemic may significantly affect emergent admissions to hospital (as in case of acute appendicitis), leading to delayed surgical interventions and its consequences.

Complicated destructive appendicitis: finding the optimal treatment method

Aim. To analyze the current practice for the surgical treatment of destructive acute appendicitis complicated by typhlitis and periappendicular abscess.&#x0D; Methods. This study analyzed the treatment outcomes in 84 patients with acute destructive appendicitis aged 18 to 79 years who were treated in the Department of Surgery No. 2 of the City Clinical Hospital No. 7 of Kazan between 2016 and 2021 years. According to the method for completion of surgical intervention, patients were divided into 2 groups, similar in age, duration of the disease and morphological changes in the appendix. In the comparison group, 54 patients had the surgical intervention completed by gauze-glove drainage of the appendix bed. In 30 patients of the main group, the appendix stump and the adjacent intestinal wall was covered with a Tachocomb plate. Then the VAC system with the Vivano device and supplies from Hartmann Group (Germany) was connected. The statistical significance of the differences between the indicators was assessed by using the Student's t-test.&#x0D; Results. The analysis of the surgical techniques used showed that in the main group, postoperative wound complications decreased by 3 times (23.3% of patients, p=0.04), intra-abdominal fluid collections decreased by 2 times (6.7% of patients, p=0.02), the hospital lengths of stay decreased by 1.8 times (p=0.02) compared with the comparison group.&#x0D; Conclusion. The use of ligature appendectomy in combination with plastic closure of the appendix stump with a TachoComb and the technology of local vacuum-assisted laparostomy in patients with destructive appendicitis complicated by periappendicular abscess contributes to a 3-fold reduction in wound postoperative complications and reduces the hospital lengths of stay in this group of patients by 1.8 times.