Suspicion Of Acute Appendicitis Research Articles

Comparative Study between RIPASA Scoring System and ALVARADO Scoring System in Diagnosing Acute Appendicitis in Adults

Background: Acute appendicitis is regarded as one of the most common inflammation that needs surgical intervention. Different scoring systems have been used for diagnosing of acute appendicitis. ALVARADO score is one of the most widely used score in diagnosing of acute appendicitis, but the accuracy of the latter is insufficiently low in Middle-East patients. Thus a new scoring system called RIPASA score has been designed for diagnosing of acute appendicitis in those patients. The aim of this study is to use RIPASA score and compare its result with ALVARADO score in diagnosing of acute appendicitis. Subjects and Methods: The study includes 200 patients with symptoms and signs of acute appendicitis in Al-Kindy Teaching Hospital/Baghdad/Iraq from 1st of November 2017 to 30th of November 2018. The variables of both scoring systems are registered for each patient included in this study and all patients who are underwent appendectomy their specimens are sent for histopathology. Results: The study includes 200 patients with suspicion of acute appendicitis. By applying both scores for each patient, then comparing the result of the two scores with the histopathology reports; RIPASA score has shown sensitivity, specificity, and diagnostic accuracy (93.6%, 74.4%, 89.5%) more than ALVARADO score (82.8%, 65.1%, 79%) respectively. The area under the receiver operating characteristic (ROC) curve of RIPASA score (0.957) is higher and significantly better than that of ALVARADO score (0.893) with P value <0.05. Conclusions: The RIPASA score is more sensitive, more specific, and has high diagnostic accuracy than ALVARADO score.

Predicting Role of the Appendicitis Inflammatory Response Score in Diagnosis and Risk Stratification of Acute Appendicitis among Adult Patients

Background: Appendicitis is a global disease. Understanding the global evolution of appendicitis in highly industrialized countries and in newly industrialized countries is necessary for planning healthcare resource utilization. Scoring systems have been designed to aid in the clinical assessment of patients with acute appendicitis. The recently introduced Appendicitis Inflammatory Response (AIR) score was designed to overcome these drawbacks. This simple clinical score can correctly classify the majority of patients with suspected appendicitis. To evaluate the AIR score on patients with suspicion of acute appendicitis and its risk stratification and assess the sensitivity and specificity of the AIR score. Materials and methods: This descriptive of observational study was carried out in the Department of Surgery, Chittagong Medical College Hospital, Chattogram from 21st March to 20th September 2017. Total 100 cases of appendicitis patients were selected after careful history taking, thorough general and local examination and appropriate investigations fulfilling inclusion and exclusion criteria. Results: The present study of 100 selected cases reveals that maximum number of patients (54.0%) were between 15-25 years age group, mean age of appendicitis was 24.5±8.9 years. The sensitivity and Specificity of the Appendicitis Inflammatory Response Score (AIR score) in diagnosis and risk stratification of acute appendicitis was 85.2% and 96.9% respectively. Similarly, the positive predictive value and accuracy rate for the same is 93.5 % and 93.0% respectively. Conclusion: Through associating easily applicable clinical criteria and two simple laboratory tests AIR score help in diagnosis and risk stratification of suspected appendicitis and could guide decision-making to reduce admissions, optimize utility of diagnostic imaging and prevent negative explorations. IAHS Medical Journal Vol 5(2), Dec 2022; 46-51

Clinical case severe course of coronavirus infection (COVID-19) in a child

A clinical case of a severe course of coronavirus infection (COVID-19) in an adolescent is described. A 15-year-old patient was admitted to the surgical department with suspicion of acute appendicitis. According to the results of the ultrasound examination of the abdomen it was decided to perform diagnostic laparoscopy, which excluded the presence of acute surgical pathology. The increase of intoxication symptoms and the data of epidemiological anamnesis, concerning the contact with patients with the catarrhal symptoms 3-4 weeks before the disease onset, were the reason for the examination for SARS-CoV-2. On the basis of a positive polymerase chain reaction for SARS-CoV-2 and existing pneumonia according to X-ray examination of the chest, the patient was transferred to an infectious disease hospital. Further examination revealed polyserositis (ascites, pleurisy); acute kidney damage (high levels of urea, creatinine, oliguria); cytolytic syndrome (increased level of aspartate aminotransferase in 1,7 times); high level of C-reactive protein and increased level of procalcitonin, which corresponded to the local infection. After the administration of the first dose of intravenous immunoglobulin the patient's condition has improved significantly. The set of symptoms of multiple organ damage in this clinical case provides grounds for differential diagnosis between coronavirus disease and multisystem inflammatory syndrome in children on the background of the coronavirus infection COVID-19. Based on the diagnostic criteria for multisystem inflammatory syndrome in children presented by the World Health Organization, the Centers for Disease Control and Prevention, the British Medical Journal, the American Academy of Pediatrics, this clinical case can be considered as multisystem inflammatory syndrome.

CLINICOPATHOLOGICAL STUDY OF ACUTE APPENDICITIS – CORRELATION OF ALVARADO SCORING SYSTEM WITH INTRA OPERATIVE AND HISTOPATHOLOGICAL FINDINGS

BACKGROUND/ OBJECTIVE- Acute appendicitis (AA) is one of the most common surgical emergencies that require a proper diagnosis to avoid a negative outcome in the case of missed or delayed diagnosis. Our study aims to assess the diagnostic power of the Alvarado score and the prediction of the severity of acute appendicitis in correlation to intraoperative ndings and the nal histopathology (HP) result. METHODSPatients with suspicion of acute appendicitis were selected for the study, which were divided into 3 groups based on their ALVARADO scoring system after routine blood investigations and ultrasonography. Out of the 100 patients RESULTS- 53 were male and 47 were females.The number of patients were highest in the age group 21- 30 years [45%] indicating predominance in younger age group. Amongst them, 81 were operated and 19 were managed conservatively. Out of 81 patients operated, intra operatively 8 patients were found to have appendicular abscess and 7 patients had a perforated appendix, rest of the 66 patients had features of inamed appendix. These ndings were further conrmed on histopathological reporting. Only 2 cases were missed by Alvarado scoring, but both patients had increased scores on reassessment and they were operated. Complex or more advanced disease was encountered in patients with higher Alvarado score. In this study the sensitivity, specicity, positive predictive value and negative predictive value were 97.5%, 68.4%, 92.94% and 86.6% respectively. Alvarado Scoring Sy CONCLUSION- stem has a high sensitivity. The Alvarado scoring system in patients with pre- operative clinical diagnosis of appendicitis has been useful in the early diagnosis of acute appendicitis as demonstrated by various studies and was helpful in reducing the incidence of negative appendicectomies without increasing the morbidity and mortality. Difculty in surgery can be anticipated in patients with high Alvarado scores.

Diffusion-weighted imaging versus non-contrast magnetic resonance imaging in the diagnosis of acute appendicitis during pregnancy

The aim of this study was to evaluate the diagnostic performance of diffusion-weighted imaging compared to non-contrast magnetic resonance imaging in the differential diagnosis of acute appendicitis in pregnant patients. A total of 72 pregnant patients with the suspicion of acute appendicitis who underwent magnetic resonance imaging combined with diffusion-weighted imaging examinations were enrolled in this retrospective study. Magnetic resonance imaging images (non-contrast and diffusion-weighted imaging sequences) were evaluated. Moreover, apparent diffusion coefficient ratios were estimated. The diagnostic performances of magnetic resonance imaging and diffusion-weighted imaging findings were statistically analyzed on the basis of surgical and follow-up results. Of 72 pregnant patients, 10 (14%) had acute appendicitis on magnetic resonance imaging and diffusion-weighted imaging. Among 10 patients with acute appendicitis, three (3/10) had perforation. diffusion-weighted imaging findings had higher sensitivity (90 versus 60%), negative predictive value (98.41 versus 93.94%), and accuracy (98.61 versus 94.44%) ratios compared to non-contrast magnetic resonance imaging in the diagnosis of acute appendicitis. There was one false-negative result on diffusion-weighted imaging. Diffusion restriction facilitated the detection of appendicitis. The apparent diffusion coefficient ratios were lower in acute appendicitis than in the normal appendix (0.70±0.19 versus 0.96±0.16) (p<0.05). With a shorter scan time and higher diagnostic accuracy, diffusion-weighted imaging can be useful for the early diagnosis of acute appendicitis and for planning appropriate management.

Cistadenoma mucinoso del apéndice cecal en paciente con cuadro clínico de apendicitis aguda operado de apendicetomía por laparoscopia

Mucoceles of the appendix are rare, predominate in women and usually present as a palpable mass in the right lower quadrant. Most patients are asymptomatic. The mucocele is defined as a cystic dilatation of the appendicular lumen caused by mucin accumulation. We present the case of a male patient in his seventh decade with clinical symptoms of acute abdomen with suspicion of acute appendicitis, laparoscopic hemicolectomy surgery was performed after finding findings of tumor dependent on ascending colon (blind region), indurated 80 × 100 mm approximately, performing right hemicolectomy plus ileocolonic lateroterminal anastomosis with adequate postoperative evolution. Keywords: Mucocele; appendix; appendicitis.

The RIPASA score in comparison to the ALVARADO score for diagnosis of acute appendicitis.

Objective: To compare the efficacy of RIPASA score with Alvarado Score in terms of diagnosing acute appendicitis. Study Design: Comparative study. Setting: Surgical Unit V, Faisalabad Medical University, Faisalabad. Period: January 2018 to January 2019. Material &amp; Methods: We recruited 100 consecutive patients who presented in surgical emergency ward with complain of pain right iliac fossa having suspicion of acute appendicitis. All patients underwent routine blood investigation, USG abdomen was performed. Then they were scored on the basis of Alvarado and RIPASA scoring system. Per operative findings were noted and confirmed by histopathological examination. Results of RIPASA and Alvorado score were tabulated using appropriate statistical analysis. Results: in our study, 94 cases had RIPASA score of 7 and above while 31 cases had ALVARADO score more than 7. Histopathology report was positive in 93 case while 07 cases turned out to be normal. Sensitivity of RIPASA score 95.69% and ALVARADO 32.25%. Specificity of RIPASA was 33.33 % while of ALVARADO 85.71%. Conclusion: Our study concludes that RIPASA score stands better as compared to Alvarado score for diagnosis of acute appendicitis.

Comparison of Appendicitis Inflammatory Response (AIR) and Lintula scoring systems in diagnosing acute appendicitis among children.

Appendectomy is still the best treatment for acute appendicitis in pediatric patients. Given the problems of early and immediate diagnosis of acute appendicitis, defining the best diagnostic protocol for this condition is of utmost importance. Different diagnostic methods, such as Lintula and appendicitis inflammatory response (AIR) scoring systems, are used for this purpose. This study aims to compare Lintula and AIR scoring systems among children with suspicion of acute appendicitis regarding their postoperative outcomes. During two years, a prospective multicentric study was carried out in the selected hospitals of Iran. Pediatric patients admitted with the diagnosis of acute appendicitis were enrolled in the study. Before decision making, each patient's score was calculated according to two appendicitis scoring systems of Lintula and AIR. The clinical outcomes and diagnosis of patients were then compared to the results of each scoring system. For those patients who were a candidate to undergo surgery, the final diagnosis of acute appendicitis was made by histopathology. Patients were divided into high and low-risk groups according to scoring systems outcomes. Among the patients with lower scoring for appendicitis, the AIR scoring system had a sensitivity and specificity of 95%, which was more promising than that of the Lintula system (19%); however, the specificity was comparable between the two models (74% vs. 83%). For patients at higher risk of acute appendicitis, although the AIR scoring systems did not provide reliable results (sen: 45% and spe: 25%), the Lintula scoring showed remarkable sensitivity (87%), accompanied by a high diagnostic accuracy (87%). AIR and Lintula scoring systems are not accurate models to predict the risk of acute appendicitis among children; therefore, they can serve as an adjacent modality for other diagnostic methods.

Histopathological Evaluationof Appendectomy Specimens in a Tertiary Care Hospital

Objective: To find out the histopathological findings in appendectomy specimens, negative appendectomy rate (NAR) and the association of gender and age groups which underwent negative appendectomies in our set up.&#x0D; Study Design: Cross sectional study.&#x0D; Place and Duration of Study: POF Hospital, Wah Cantt, from Jan to Aug 2017.&#x0D; Methodology: The records of 1050 patients were assessed for the relevant clinical history, age, gender and date of their presentation in hospital. The appendectomy specimens were classified as positive specimens which contained fecoliths, worms, granulomatous inflammation, foreign body reaction, mucocele, or appendiceal tumors. All the data were entered and analyzed in SPSS-21.&#x0D; Results: Among the 1050 patients with suspicion of acute appendicitis, 458 (43.6%) were cases of acute appendicitis followed by acute suppurative appendicitis 100 (9.5%) and fecolith 79 (7.5%) in appendiceal lumen. The negative appendectomy rate was calculated as 248 (23.6%). A significant association of normal appendices was found with female gender (p=0.002) and young age group (p=0.02).&#x0D; Conclusion: Acute appendicitis was the most frequent histopathological finding in our study. The negative appendectomy rate was significantly associated with the females of young age.

THE DIAGNOSTIC ACCURACY OF CLINICALAND LABORATORY PARAMETERS IN THE DIAGNOSIS OF ACUTE APPENDICITIS IN THE ADULT EMERGENCY DEPARTMENT POPULATION

The aim of the study was to identify the optimal combination of clinical and laboratory parameters that should facilitate the emergency department surgeon's denite decision. The study group comprised 120 patients with suspicion of acute appendicitis (AA). In 60 patients the AAdiagnosis was conrmed intraoperative and by histological analysis. Clinical parameters included: appetite, vomiting, diarrhoea, dysuria, signs of localized peritonitis and pain migration. Measured laboratory parameters were: C-reactive protein (CRP), complete blood count (CBC) and the urine test strip. The control group of patients were more likely to present following symptoms: no changes in appetite (P &lt; 0.001), diarrhoea (P = 0.009) and dysuria (P = 0.047). CRP and white blood cell count (WBC) were signicantly higher in the group with conrmed AA compared to the control group (44.7 vs. 6.6, and 13.6 ± 3.9 vs. 9.0 ± 3.4, respectively; P&lt; 0.001). The multivariate logistic regression analysis identied lack of appetite (P= 0.013), absence of diarrhoea (P= 0.004), and positive nding of signs of localized peritonitis (P= 0.013), as well as WBCs (P&lt; 0.001) and negative urine test strip results (P = 0.009) as statistically signicant predictors of AA. The highest percentage of correctly classied cases (82%) was achieved by combination of common clinical exam and basic inexpensive laboratory parameters (WBCs and urine test strip). Acute appendicitis in the emergency setting may be successfully ruled in based on elevated WBCs and negative urine test strip in combination with signs of localized peritonitis, lack of appetite and absence of diarrhoea. Since CRP did not contribute to the overall diagnostic accuracy, its use in AA diagnostic protocols is of no value.

RIPASA versus Alvarado score in the assessment of suspected appendicitis in children: a prospective study

BackgroundDiagnosis of acute appendicitis remains a problem in children with right lower quadrant pain.Challenging diagnosis and fears of missing an inflamed appendix may lead to a negative appendectomy. Many scoring systems have been developed to reduce ambiguities in the diagnosis of appendicitis. Alvarado is one of the most commonly used scoring methods in pediatric patients. The RIPASA score is considered to be a better diagnostic scoring method in adults compared to Alvarado. The present study aims to compare RIPASA and Alvarado scoring systems in determining the possibility of acute appendicitis in children with right lower quadrant pain.This study included 179 consecutive pediatric patients who were referred to pediatric surgery with suspicion of acute appendicitis. The cut-off value was >7.5 for the RIPASA score vs. ≥7 for the Alvarado score. The possibility of appendicitis was divided into three groups for the Alvarado score and four groups for the RIPASA score.ResultsIn this study, 158 of 179 patients were operated on. In 140 of the operated patients, the diagnosis of appendicitis was confirmed by histopathology. The negative appendectomy rate was 11.4%. Specificity and negative predictive value of RIPASA score were higher than those of Alvarado (p<0.001). No difference was found between the two scores concerning sensitivity, positive predictive value, and the area under the receiver operator characteristics curve (p>0.05).ConclusionThe RIPASA scoring system can be used as an alternative to the Alvarado scoring system in the management of patients with right lower quadrant pain in emergency services and pediatric outpatient clinics. With the use of the RIPASA score, more patients with a low likelihood of appendicitis can be detected and further contributed to the reduction of the negative appendectomy rate.

A RARE CASE OF VALENTINO SYNDROME- CASE REPORT

Background: Valentino’s syndrome refers to acute abdomen with clinical presentation mimicking acute appendicitis in a Perforated gastric or duodenal ulcer. This occurs when suppurative fluid from duodenal perforation trickles down the paracolic gutter to the right iliac fossa causing peritonitis locally and causes periappendicitis. Less than 50 cases have been reported in literature of the same.&#x0D; Case report and discussion: A 42-year-old male was admitted to the general surgery department with pain in the right iliac fossa and epigastric region. A diagnostic laparoscopy was performed under the suspicion of Acute appendicitis, which was later converted to open laparotomy on finding a perforated duodenal ulcer.&#x0D; Review of Literature: Valentino syndrome is a rare condition in which a duodenal ulcer mimics acute appendicitis which is a diagnosed intraoperatively and managed surgically.&#x0D; Although the exact incidence is unknown, less than 50 cases have been reported worldwide. The first incidence reports back to 1926 when an Italian actor, Rodolfo Valentino who succumbed to this rare disease and it was named after him.&#x0D; Conclusion: Differential diagnosis of duodenal ulcer perforation should be considered for adult patient with diagnosis of acute appendicitis. X ray erect abdomen and diagnostic laparoscopy can help to overcome foot in mouth situation due to missed duodenal ulcer perforation.&#x0D; Keywords: Valentino syndrome.&#x0D;

COMPARISON OF ALVARADO SCORE AND RIPASA SCORE IN THE ACCURATE DIAGNOSIS OF ACUTE APPENDICITIS IN COMBINED MILITARY HOSPITAL RAWALPINDI

Objective: To determine the diagnostic accuracy of Alvarado score and the RIPASA score for acute appendicitis using histopathology as a gold standard.&#x0D; Study Design: Cross sectional validation study.&#x0D; Place and Duration of Study: Department of General Surgery, Combined Military Hospital, Rawalpindi Pakistan, from Mar to Sep 2018.&#x0D; Methodology: A total number of 270 patients were included in the study presenting with pain right iliac fossa to the Accident and Emergency department. Surgeons and Seniors Residents in Surgery on call in the Accident and Emergency Department. Combined Military Hospital, Rawalpindi, scored the patients with suspicion of acute appendicitis with Alvarado Score and RIPASA score simultaneously. After appendectomy of these patients, the removed appendix was sent for histopathology to confirm whether it was normal or inflamed. A 2x2 table was used for calculating sensitivity, specificity and diagnostic accuracy of the RIPASA score and Alvarado Score. The two scoring systems were then compared for diagnostic accuracy.&#x0D; Results: In our study, the sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy of RIPASA score and Alvarado score for diagnosing acute appendicitis were 92.1%, 62.1%, 95.2%, 48.6%, 88.9% and 72.6%, 68.9%, 95.1%, 23.2%, 72.2% respectively.&#x0D; Conclusion: The diagnostic accuracy of RIPASA score was more than that of Alvarado score in diagnosing acute appendicitis.

651 An Audit of Negative Appendectomy Rate at A District General Hospital in the UK

Abstract Aim There is significant variation in management of acute appendicitis across the UK. Despite advancements in imaging modalities, acute appendicitis is still a clinical diagnosis. The primary aim of this study was to determine the negative appendectomy rate (NAR) and secondary aim was to look for the imaging results and hospital readmission rate in case of a normal appendix. Method It is a retrospective analysis of all the patients admitted with a suspicion of acute appendicitis from Jan 2018 to April 2019. For data collection hospital medical record was used. Information about patient demographic details, blood results, outcome, operative findings, and histology of appendix if removed, was collected. For Patients having negative appendectomy, hospital admission rate was calculated. Results Total 517 patients were admitted with suspected acute appendicitis and only 45.6% (n = 236) patients underwent surgery. Females=52.1%, Males 47.9%. Mean age was 31 years. NAR was 10.6% (n = 25). (Females= 9.3%, Males=1.3%), 8.4% female patients were below 35 years of age. Patients were divided into 3 groups (Normal appendix NA, Uncomplicated appendicitis UA, complicated appendicitis CA). There was a statistically significant difference in inflammatory markers between the groups. In NA group 17/25 patients underwent prior imaging and imaging suggested acute appendicitis in 7/17 patients. Post NA hospital readmission rate was 20%, all of them were females, and gynecology opinion was sought in all of them. Conclusions The negative appendectomy rate is at 10.6%, comparable to national database. It is more common in young females due to a range of differential diagnoses.

Subhepatic Appendicitis: A diagnostic conundrum

One of the most common presentations of acute abdominal pain in the emergency setting is appendicitis. Although it can occur in both genders, when it comes to females with appendicitis, reaching a definite diagnosis can be challenging as it can mimic other diseases such as ovarian cysts/torsions, pelvic inflammatory diseases, endometriosis, and urinary tract infection or physiological reasons like menstrual pain which are exclusive to females and can occur as frequently as appendicitis. Therefore, it is crucial to make an accurate diagnosis as early as possible with the right diagnostic tools to reduce morbidity and mortality in females of child-bearing age. This is a summarized case report of an adolescent female who experienced two atypical attacks of appendicitis 1 year apart. Since the patient had mainly right upper flank pain associated with nausea, vomiting, and fever with a largely non-tender abdomen, various diagnoses such as chronic cholecystitis, biliary colic, peptic ulcer, gastroenteritis, mesenteric lymphadenitis, renal colic, mittelschmerz, and torsion of ovarian cyst were considered and treated for. The patient had no relief and underwent numerous investigative procedures in the 2 years she suffered from her illness. The final diagnosis was only obtained when exploratory laparoscopy was performed. This article aims to remind clinicians to have a high index of suspicion for acute appendicitis in all atypical presentations of acute appendicitis. The latest WSES Jerusalem guidelines for the workup for patients at risk of acute appendicitis should be meticulously followed.

978 Acute Appendicitis in The Age of COVID-19 – How Changing Standards Affect Patient Outcomes

IntroductionThe COVID-19 -19 pandemic has forced changes in the management of Acute Appendicitis (AA), such as prioritising conservative management and avoiding laparoscopic procedures. We aim to assess how these changes affected patient outcomes in comparison to routine practice during the same time frame in 2019.The primary study outcomes are operative intervention, length of stay and hospital re-admission within 30 days.MethodRetrospective data collection for all patients admitted to Ipswich Hospital with suspicion of AA since lockdown came into effect in England on March 23 up to May 10th, 2020 and the same time frame in 2019.Results23 patients were admitted during the lockdown period. 39%(N = 9) were treated conservatively.14 (61%) operatively, of which 71% (N = 10) had open appendicectomy while 29% (N = 4) underwent laparoscopic appendicectomies. The mean Length of Stay(LOS) was 3.83 days. In 2019,21 patients were admitted. 33%(N = 7) were treated conservatively. All appendicectomies were laparoscopic. Mean LOS was 2 days.Re-admission rates were similar in both groups.ConclusionsDue to Covid19 a majority of patients requiring surgery underwent open appendicectomies. We noted a significant increase in both length of stay and progression from non-operative to operative intervention rates compared to 2019. The general case load was similar.

Evaluation of CA-125 Biomarker in Acute Appendicitis Patients: Correlation with Clinical Symptoms and Lab Results

Objectives: The aim of this study is to evaluate the diagnostic significance of CA 125 in Acute Appendicitis (AA) along with the changes in its levels about clinical symptoms and lab findings. Methods: Patients referred at the emergency department of Madani hospital with the suspicion of AA and right iliac fossa pain were enrolled in this study. Preoperative CA 125 levels along with C-reactive Protein (CRP) and complete blood count were obtained. Lab findings, signs and symptoms were recorded for all the patients. Statistical analysis was conducted based on CA 125 &lt; 16.4 U/mL and ≥ 16.4 U/mL using the logistic regression model, where variables such as fever, anorexia, CRP and Erythrocyte Sedimentation Rate (ESR) were added to the model. Results: Of 207 patients with the mean age of 26.55 ± 0.967 years, 48.8% of them were males and 51.20% were females. 122 of the total patients had CA 125 ≥ 16.4 U/mL. Anorexia was significantly associated with increased levels of CA 125. CA 125 was 2.14 times higher in patients presenting anorexia. However, ESR, CRP and fever were not associated with the elevation of CA 125. Based on the contour plot, it was deduced that leukocytosis at its lowest and erythrocyte sedimentation rate at its highest levels is associated with the maximum concentration of serum CA 125. Conclusion: Based on the findings from this study, CA 125 cannot be considered as a reliable diagnostic variable for acute appendicitis. Levels of CA 125 may vary with the severity of AA.

Neurogenic appendicopathy: an underestimated disease-systematic review of the literature.

Appendectomy is one of the most frequently performed surgeries worldwide, but neurogenic appendicopathy (NA) remains a poorly understood disease with controversial clinical management. The aim of this review was to obtain a clear definition of the disease and summarize its management. We performed a systematic review of the literature on NA in PubMed, EMBASE, Web of Science, and Cochrane databases from inception to 19/01/2021 according to PRISMA statement standards. Eligibility criteria were original articles examining histopathology, clinical management, and/or follow-up of patients with NA. The literature review is complemented by a clinical case. In 40 articles, the estimated incidence of NA among appendectomies performed in patients with a suspicion of acute appendicitis (AA) was 10.4% (N = 740, range 1.8-32%). NA more frequently causes recurrent and longer lasting pain compared to AA; however, these diseases are usually not clinically or radiologically distinguishable. Based on our analysis, NA is defined as the presence of three criteria: (1) clinical presentation of AA, (2) absence of acute inflammation on histopathology, and (3) presence of S-100-positive spindle cells or proliferation of Schwann cells. Laparoscopic appendectomy has been shown to be a safe and successful treatment. NA is a poorly known disease, which may clinically appear as AA but is often related to recurrent and longer lasting abdominal pain. Patients with NA may suffer for years before diagnosis. In cases of typical symptoms, appendectomy should be performed even in cases of macroscopically and radiologically normal-appearing appendices with normal laboratory results.

Diagnosis of acute appendicitis in children using urinary 5-hydroxy indol acetic acid and pediatric appendicitis score: A randomized control trial

PurposeAcute appendicitis in children represents a common problem. Diagnosis may be difficult due to lack of clinical data. Several scoring systems and laboratory investigations are used for diagnosis. This study aimed to build a model for diagnosis of acute appendicitis in children using urinary 5-hydroxyindoleacetic acid (5-HIAA) and pediatric appendicitis score. MethodsThis study was conducted on 191 children with suspicion of acute appendicitis. They were divided into two groups A and B. Children were evaluated in group A with pediatric appendicitis score, ultrasound, and CRP. In group B children were evaluated in the same manner of group A plus measuring of 5-HIAA. Resultsmean age was 13.3 ± 5.2 years. The mean duration of symptoms was 2.2 ± 1.4 days. The mean level of urinary 5-HIAA was 43.53 ± 24.05 in appendicitis patients in group B. In group A there were 65 cases who had appendectomy. Seventy-five children were operated in group B. Negative appendectomies were found in 13 and 7 cases in groups A and B respectively. Thirteen cases were readmitted in group A with diagnosis of acute appendicitis while seven cases were readmitted in group B. ConclusionThis combination of urinary 5-HIAA and pediatric appendicitis score builds a model for diagnosis of acute appendicitis in children. This model improves the accuracy of diagnosis of acute appendicitis, reduces both the incidence of negative appendectomies and the incidence of readmission or missed cases in children.

Is Alvarado Score Helpful for Pediatrician in Diagnosis of Acute Appendicitis? Our Center Experience

Background: Many problems in the diagnosis of patients with suspected appendicitis have led to the design of clinical scoring systems. In children, diagnostics tools for appendicitis are more critical. Younger patients, diagnostic challenges become more. Practical scoring systems are useful without any particular material and necessitate novel ability. Objectives: However, in spite of the reported outstanding consequences, these scoring systems are not employed regularly. Methods: In this cross-sectional study performed from October 2016 to October 2017, ten provinces out of the 31 provinces in Iran were randomly selected. A total of 631 patients referring to the hospitals with the suspicion of acute appendicitis were assessed. Related variables such as age, sex, right lower quadrant (RLQ) pain, migration of pain to RLQ, nausea, and presence of vomiting, anorexia, tenderness in RLQ and guarding, presence of rebound tenderness, and degree of fever were taken from recorded files by pediatricians. Alvarado scoring system was used for included cases to assess the accuracy of this test for diagnosis of appendicitis in our centers. Results: The mean age of eligible patients was 9.3 ± 3.21 years ranged from 3 years to 18 years, and 380 (60.5%) were male. Using the Alvarado score system in this study, considering the cut-off point value of 7 to decide for operation, the positive predictive value (PPV) showed 32.6%, and negative predictive value (NPV) was 76.73%, with a sensitivity of 44.05% and, specificity of 66.95%. There were statistically no significant correlations among the scoring of the Alvarado and diagnosis of AA (P &lt; 0.05). Regarding receiver operator characteristic curves (ROC), the area under curve (AUC) was 0.58 (0.54 to 0.63) for Alvarado. The AUC was very low, so there was no value for the diagnosis of appendicitis. According to the findings of the present study, the cut-off point of 4.5 is suggested for the diagnosis of acute appendicitis in children with a sensitivity of 73% and specificity of 58%. Conclusions: Although the Alvarado scores supply obviously practical diagnostic information in the management of pediatric population with supposed appendicitis, this method delivers no adequate PPV for clinical practice as a safe way for determining necessary operation.