Symptoms Of Appendicitis Research Articles

A Case-control Study on the Correlation between Serum Bilirubin Levels and Various Types of Appendicitis

Background Acute appendicitis is one of the most common types of surgical emergencies. Among laboratory factors, hyperbilirubinemia has recently been identified as a strong predictor of preoperative perforation and gangrene. Aim This study aimed to investigate the correlation between serum bilirubin levels and types of appendicitis. Methods This case-control study was conducted in 2022 using the convenience sampling method on 100 patients who were referred to the emergency department of Imam Khomeini Hospital in Jiroft with abdominal pain. These patients were diagnosed with appendicitis based on the initial clinical examinations. The white blood cells and total bilirubin levels were measured for all the patients. Intraoperative macroscopic findings were recorded by the surgeon, and the pathological results of the specimen were reported. Data was analyzed using SPSS 24, including descriptive and inferential statistics at the significance level of P<0.05. Results Among 100 patients aged between 28.5±14.8, 48% were men, and the rest were women. There was a significant difference between the mean of bilirubin levels in patients with complicated and uncomplicated appendicitis (P <0.01). The results of logistic regression analysis showed that the period of onset of symptoms to hospitalization, leukocytosis level, and preoperative total bilirubin level were significant variables for diagnosing complicated appendicitis (P<0.05). Conclusion In this study, we found that patients with complicated appendicitis had higher total bilirubin levels than patients with uncomplicated appendicitis. Therefore, patients with hyperbilirubinemia and clinical symptoms of appendicitis should be considered as more probable cases of perforation than those with normal bilirubin levels.

Access to Healthcare for Appendicitis Patients in the United States Based on Insurance Coverage.

Health insurance plays a crucial role in ensuring access to healthcare services, addressing affordability concerns.Insurance options have varying wait times and acceptance challenges, which can greatly impact patients in emergency conditions, such as appendicitis. This study aims to find out the healthcare access disparities for appendicitis patients in states with low Medicaid coverage. A three-week virtual cross-sectional study (Oct 20-Nov 10, 2023) evaluated healthcare accessibility for appendicitis symptoms in North Dakota, Utah, Wyoming, and New Hampshire. Using www.healthgrades.com, data on general surgeons within 10 milesprioritizing new patients with three stars or above were collected and then analyzed with StataCorp 2023. The study was done among 81 physicians among whom, 61 (75.31%) were maleand 20 (24.69%) were female, mostly MD (76, 93.83%), DO (3, 3.70%), and APRN (2, 2.47%). Cigna (n=77) is mostly accepted by more physicians than Medicaid (n=33) across the states. The average waiting period for Cigna (9.45±10.54 days) is mostly longer than Medicaid (4.71± 9.63 days). Our findings of P-values >0.05reveal no significant associations in insurance acceptance or waiting times. Although varying wait times were observed across states, no significant disparities were found in appointment waiting periods based on insurance types.

Non-Operative Management of Uncomplicated Appendicitis in Children: Can Patients Be Discharged From the Emergency Department?

IntroductionNon-operative management of uncomplicated appendicitis in children is a safe alternative to laparoscopic appendectomy. The purpose of this study is to determine the feasibility of nonoperative outpatient management of uncomplicated appendicitis in pediatric patients. MethodsA standardized pathway for non-operative outpatient management of uncomplicated appendicitis in children (NOMA-C) was implemented in a university pediatric surgery practice starting October 2021. Those who met criteria would be considered for discharge from the emergency department (ED) with oral antibiotics and close followup over the following year. A quality improvement project started concurrently to monitor patients for recurrent symptoms of appendicitis. ResultsA total of 121 patients were diagnosed with acute appendicitis during the study period (October 2021 to April 2023). Forty-five children (38%) met criteria for the NOMA-C protocol, and 11 patients/families chose appendectomy. Of the 34 patients who pursued nonoperative management, 14 patients were admitted to the hospital and 20 patients were discharged from the ED. Total time in the ED/hospital was significantly shorter for patients discharged from the ED (7 hours versus 23 hours; p<0.001). At one year follow up only 4 (12%) had undergone appendectomy. There were no adverse events for patients who underwent nonoperative management. ConclusionA protocol offering non-operative management of appendicitis with an option for outpatient management was feasible and safe. Outpatient management was associated with shorter ED/hospital stays than those admitted. Future studies should evaluate whether this protocol can be adopted by EDs without pediatric surgery services to avoid the need for transfer.

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

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

Exploring Anatomical Variations of the Vermiform Appendix on Multidetector CT

Acute appendicitis is the most common cause of acute abdominal pain requiring urgent abdominal surgical intervention. Computed tomography (CT) is the preferred imaging examination for the evaluation of patients due to its high sensitivity and specificity. The appendix is a highly variable organ with many possible configurations of its location. Depending on the position of the appendix, the signs and symptoms of appendicitis may also vary and mimic other surgical conditions. Diagnosing appendicitis requires an understanding of the anatomy of the vermiform appendix, which may vary from patient to patient. This study aims to describe the prevalence of anatomical variations of the vermiform appendix on multidetector CT (MDCT). Methods: A retrospective review of consecutive abdominal CT exams (age ≥ 15) performed over eleven months was done. The final study population consisted of 669 patients, 317 men and 352 women, mean age of 51.85 years ± 16.39 (SD), age range, 15-91 years. A classification system was used to describe the different positions of the appendix apex. Results: The most common location of appendix apex was subcecal in 180 (26.9%), followed by pelvic in 153 (22.9%), midline in 130 (19.4%), retrocecal in 100 (14.9%), postileal in 29 (4.3%), paracecal in 20 (3%), others in 19 (2.8%), antececal in 18 (2.7%), hepatic in 14 (2.1%), preileal in 6 (0.9%). Analysis of relative frequencies of appendix locations in relation to patient gender using a chi-square test showed that the pelvic and post-ileal positions of the appendix were statistically significantly higher in females compared to males (p&lt;0.0001, P=0.0158 respectively). The most common

Successful Gastrografin Vermifugation for Taenia saginata-associated Appendicitis.

In Japan, public health improvements have lessened parasitic infections, but increased global travel has introduced new disease risks. We report the case a Japanese man who had previously resided in Vietnam, who experienced appendicitis and the presence of segments in his stool. Gastrografin led to the expulsion of Taenia saginata, as confirmed by scolex identification. Remarkably, the appendicitis symptoms subsided after deworming. This case underscores the importance of considering cestode infections in the differential diagnosis of appendicitis, particularly for patients with relevant travel histories, and highlights the evolving challenges in global health and the significance of acquiring detailed patient histories.

Endoscopic retrograde appendicitis therapy in adults with uncomplicated acute appendicitis: a systematic review and meta-analysis

Background and AimsEndoscopic retrograde appendicitis therapy (ERAT) has emerged as a minimally-invasive, endoscopic alternative to laparoscopic appendectomy in the treatment of acute appendicitis. This systematic review and meta-analysis aims to evaluate the efficacy and safety of ERAT in treating uncomplicated, acute appendicitis. MethodsA systematic review of studies in the PubMed/MEDLINE and Cochrane databases was performed through June 2023. The primary outcomes included clinical success rate (defined as resolution in signs and symptoms of appendicitis) and technical success rate (defined as successful placement of a drain or stent within the appendiceal orifice or irrigation to relieve appendiceal obstruction). Secondary outcomes included adverse event rates and rates of intestinal perforation, procedure time, hospital length of stay, duration of follow up, and rates of appendicitis recurrence after ERAT. ResultsA total of eight studies were considered eligible for analysis (326 patients; average age 36.4 years old, 55.4% male). The rate of technical success was 98% (95% CI; 97%, 100%; I2=2.2%), and the rate of clinical success was 99% (95% CI; 97%, 100%; I2=0%). The total pooled adverse event rate was 1.8% (95% CI; 0.4%, 3.2%, I2=0%) with a pooled intestinal perforation rate of 1.5% (95% CI; 0.02%, 2.8%, I2=0%). The average procedure time was 44.9 minutes. The average hospital length of stay following ERAT was 3.22 days. The aggregate rate of appendicitis recurrence following ERAT was 6% (95% CI; 3%, 9%; I2=16.5%) after being followed for an average of 17.7 months. ConclusionsERAT demonstrates excellent technical and clinical success rates with minimal adverse events. Additional randomized controlled studies are needed to refine inclusion criteria and to standardize the approach to appendiceal stent placement during ERAT to minimize rates of intestinal perforation.

A Case with Multiple Systemic Inflammatory Syndrome Presenting with Acute Appendicitis Symptoms

A Case with Multiple Systemic Inflammatory Syndrome Presenting with Acute Appendicitis Symptoms

Incidental appendiceal neoplasms: Single-centre results.

Histopathological examination of appendectomy specimens may reveal malignancies. Based on these results, either appendectomy is sufficient or sometimes a further treatment protocol can be needed. In this study, malignancy-diagnosed cases on appendectomy specimen were examined. Patients who underwent appendectomy between January 2013 and December 2018 with a pre-diagnosis of acute appendicitis were evaluated retrospectively and those cases with malignancy were included in the study. Patients' age, sex, tumor type, tumor diameter, tumor grade, tumor localization, surgical margin, Ki-67 index, state of lymphovascular invasion, state of peri-neural invasion, and follow-up period duration were recorded. On examination of 2336 appendectomy specimens, 16 patients (0.7%) were found to have neuroendocrine tumors (NET), 11 patients (0.5%) were found to have low-grade mucinous neoplasm (LAMN), and five patients (0.2%) were found to have primary appendix carcinomas. Appendix tumors usually present with acute appendicitis symptoms. Despite re-operation with right hemicolectomy (RHC) being required in the treatment of adenocarcinoma cases, appendectomy provides adequate treatment in most cases with NET and LAMN. With these tumors, which usually have a benign prognosis, it is important to perform the necessary screening in the postoperative period and not to interrupt follow-up.

Study of Prevalence of Appendicitis in children of Bihar Population

Background: Appendicitis is quite common surgical emergency in children because it is longer in children rangesfrom 2-20 cm than adult 6-10 cm. Moreover it is most constricted part of GIT like pharynx.Method: 80 children (40 male and 40 females) below 10 years having symptoms of appendicitis and confirmedbyUSG/ST scan were operated by General anaesthesia and dissected part was sent to histo-pathology test to ruleout the exact pathology.Results: Highest incidence of acute appendicitis was observed in both sexes 23 (57.5%) male, 20 (50%)female andleast number of perforated appendicitis 10 (25%) in male, 4 (10%) in female was observed.Conclusion: Present pragmatic study of appendicitis having acute, chronic and perforation will help the surgeonto treat efficiently to avoid morbidity and mortality in children.

Appendiceal Goblet Cell Carcinoma: Role of Cytoreductive Surgery (CRS) and Hyperthermic Intraperitoneal Chemotherapy (HIPEC).

Goblet cell carcinoma (GCC) encompasses a separate entity in appendiceal neoplasms with mixed glandular and neuro-endocrine pathological features. GCC mostly presents as an acute appendicitis duo to luminal obstruction or as an incidental finding on the surgical appendectomy specimen. In case of tumour perforation or presence of other risk factors, guidelines suggest additional treatment with a completing right hemicolectomy or cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC). We report the case of a 77-year-old male with symptoms of appendicitis for which an appendectomy was performed. The appendix was ruptured during the procedure. There was an incidental finding of GCC on the pathological specimen. Because of possible tumour soiling, the patient received a prophylactic CRS-HIPEC. A literature review was performed to investigate the potential role for CRS-HIPEC as a curative treatment in patients with GCC. GCC of the appendix is an aggressive type of tumour with a high risk of peritoneal and systemic dissemination. CRS and HIPEC is a treatment option: both in a prophylactic setting and in patients with established peritoneal metastases.

Analysis of surgical treatment of appendix neuroendocrine neoplasms—17 years of single-center experience

Background/aimThis study investigated the clinicopathological characteristics and treatment of appendix neuroendocrine neoplasms in appendectomy specimens of our center.Materials and methodsThe clinicopathological data, including age, sex, preoperative clinical manifestation, surgical method, and histopathological examination results of 11 patients with appendix neuroendocrine neoplasms confirmed by surgery and pathology between November 2005 and January 2023, were retrospectively analyzed.ResultsIn the histopathological examination of 7277 appendectomy specimens, 11 cases (0.2%) had appendix neuroendocrine neoplasms. Among the 11 patients, 8(72.7%) were males, and 3(27.3%) were females, with an average age of 48.1 years. All patients underwent emergency surgery. A total of 9 patients underwent open appendectomy, including 1 patient who underwent second-stage simple right hemicolectomy after an appendectomy, and two who underwent laparoscopic appendectomy. All 11 patients were followed up for a period of 1 to 17 years. All patients survived without any indication of tumor recurrence.ConclusionAppendiceal neuroendocrine neoplasms are low-grade malignant tumors originating from neuroendocrine cells. They are rarely seen in clinical practice and are often treated based on acute and chronic appendicitis symptoms. These tumors are challenging to diagnose before surgery due to the lack of specificity in clinical manifestations and auxiliary examinations. The diagnosis generally depends on postoperative pathology and immunohistochemistry. Despite the diagnostic challenges, these tumors have a favorable prognosis.

Diarrhoea-causing microorganisms are rare in adult patients undergoing diagnostic laparoscopy for suspected appendicitis: a prospective observational cohort study.

We investigated if diarrhoea-causing bacteria, including Yersinia species, could mimic the symptoms of appendicitis and lead to surgery. This prospective observational cohort study (NCT03349814) included adult patients undergoing surgery for suspected appendicitis. Rectal swabs were analysed with polymerase chain reaction (PCR) for Yersinia, Campylobacter, Salmonella, Shigella and Aeromonas spp. Blood samples were analysed routinely and with an in-house ELISA serological test for Yersinia enterocolitica antibodies. We compared patients without appendicitis and patients with appendicitis confirmed by histopathology. The outcomes included PCR-confirmed infection with Yersinia spp., serologic-confirmed infection with Y. enterocolitica, PCR-confirmed infection with other diarrhoea-causing bacteria and Enterobius vermicularis confirmed by histopathology. A total of 224 patients were included, 51 without and 173 with appendicitis, and followed for 10 days. PCR-confirmed infection with Yersinia spp. was found in one patient (2%) without appendicitis and no patients (0%) with appendicitis (p = 0.23). Serology was positive for Y. enterocolitica for the same patient without appendicitis and two patients with appendicitis (p = 0.54). Campylobacter spp. were detected in 4% vs 1% (p = 0.13) of patients without and with appendicitis, respectively. Infection with Yersinia spp. and other diarrhoea-causing microorganisms in adult patients undergoing surgery for suspected appendicitis was rare.

Transanal protrusion ventriculoperitoneal shunt migration in hydrocephalus patients

Perforation of the abdominal visceraand protrusionofthe distal end of the ventricul operitonealshunt are uncommon but serious complications of pediatric surgery. We report a case of distal ventriculoperitonealshunt protrusion into the appendix by transanal access in a patient who did not exhibit typical appendicitis symptoms. We report the case of a 2-year-old male with anal extrusion and assess his condition.

Socioeconomic, Laboratory and Associated Factors in Patients Suffering From Acute Appendicitis

Background: Acute appendicitis (AA) is the most common clinical condition worldwide. In Pakistan, about 400,000 appendectomies are routinely carried out in surgical departments yearly. This study aims to find the latest and updated information regarding the diagnostic accuracy of CRP levels in AA. This will help surgeons make timely decisions, thus reducing the morbidity and mortality associated with complicated appendicitis. Methods: This descriptive cross-sectional study was performed at KTH Peshawar from February to august 2018. It was designed to analyze C-reactive protein levels among acute appendicitis patients using positive and negative predictive values. Histopathologically confirmed appendicitis patients were included. Results: In the current study, 216 patients suffering from Acute appendicitis were studied observed. The symptoms duration was &lt; 2days in 75% patients while &gt;2 days symptoms were found in 25% population. Majority patients were poor (46%), followed by middle class (42%), and rich (12%). Obesity was only observed in 22% patients suffering from AA. Diabetes and hypertension was observed in 18% and 15% patients respectively. Diagnostic accuracy of acute appendicitis was also calculated between CRP and Histopathology findings based on age, diabetes mellitus, gender, hypertension, obesity, and period of symptoms. Conclusion: Our study concludes that the acute appendicitis symptoms appeared in less than two days. Acute appendicitis predominantly found in poor and middle class patients. Acute appendicitis should be diagnosed based mostly on its clinical symptoms. Despite the fact that CRP is a particularly helpful marker in the clinical diagnosis of acute appendicitis, general surgeons must apply their clinical judgement. The function of CRP in acute appendicitis should be examined in future research with a bigger sample size. Keywords: C-reactive protein level, Socioeconomical factors, Acute Appendicitis, Diagnostic accuracy, Histopathological.

The Clinical, Laboratory and Imaging Tests in Diagnosing Acute Appendicitis in Children: A Retrospective Study in a Tertiary University Hospital in Tehran, Iran

Background: Acute Appendicitis (AA) is a common cause of emergency room visits among children. Non-specific symptoms of appendicitis may pose a major challenge. Due to the lack of access to imaging modalities in all facilities and its high cost, the evaluation of clinical symptoms and examination results is important in diagnosing acute appendicitis. &#x0D; Methods: This study is a retrospective cross-sectional study. Patients admitted to our emergency department and were suspected of having acute appendicitis by pediatric residents, and underwent an appendectomy during 2013-2018 were included. A checklist of the patients’ clinical signs and symptoms, and laboratory results and imaging findings completed from the records of these patients.&#x0D; Results: We reviewed the files of 300 patients with a clinical diagnosis of acute appendicitis and having an appendectomy. Leukocytosis was found in 248 (82.7%), neutrophilia in 240 (80%) and CRP level equal or above 12 mg/L was observed in 107 (35.7%) patients. Ultrasound was performed in 283 patients (94.33%); of which 228 (80.56%) were reported as acute appendicitis. Abdominal CT scan was performed in 19 patients (6.33%); of which acute appendicitis was reported in 17 patients (89.47%).&#x0D; Conclusion: The results of this research showed that RLQ tenderness, and nausea/vomiting are the most common signs and symptoms, and leukocytosis is the most common laboratory finding in children with acute appendicitis. It can be suggested that relying just on the clinical presentation of AA (RLQ tenderness, fever, nausea/vomiting, anorexia and leukocytosis), can lead to the correct diagnosis of 78% of the suspected patients.&#x0D;

Diagnostic accuracy of blood tests of inflammation in paediatric appendicitis: a systematic review and meta-analysis

ObjectivePossible childhood appendicitis is a common emergency presentation. The exact value of blood tests is debated. This study sought to determine the diagnostic accuracy of four blood tests (white cell...

Characteristics of appendicitis after immune checkpoint inhibitor therapy among cancer patients.

Immune checkpoint inhibitor (ICI) therapy has revolutionized cancer care but is associated with immune-related adverse events (irAEs). Recent case reports raised the concern that acute appendicitis may be an irAE. In this study, we sought to describe the disease course of post-ICI therapy appendicitis and its associated complications. Adult patients who had an International Classification of Diseases code for appendicitis within the first 2years after initiating ICI therapy from January 2010 to April 2021 and who had imaging evidence of appendicitis were studied retrospectively. 13,991 patients were identified who had ICI exposure during the study period, 44 had codes for appendicitis, 10 of whom met the inclusion criteria. Their median age at the time of diagnosis was 59years. The median time from ICI therapy initiation to appendicitis onset was 188days. The most common presenting symptoms were abdominal pain (70%) and fever (40%). Abscesses were present in two patients, and a perforation was present in one. All 10 patients received broad-spectrum antibiotics. Five patients needed surgery or interventional radiology drainage. Nine patients had resolution of appendicitis symptoms after treatment. Post-ICI therapy appendicitis is rare but presents similarly to and has similar complications rates as conventional appendicitis. Appendectomy remains the mainstay of treatment, but its use can be limited in cancer patients. The decision to continue ICI therapy remains at the discretion of the clinician. Further studies are needed to bring awareness to and advance the understanding of this clinical entity.

Corpus luteum rupture mimicking acute appendicitis

Acute abdomen is a common presentation in women in the reproductive age. It may be caused by diverse conditions. The case below presented with classical signs and symptoms of appendicitis. Haemoperitoneum seen at laparotomy suggested a diagnosis of ectopic pregnancy .The diagnosis of ruptured corpus luteum cyst (RCLC) was made only after histology. The symptoms, signs and diagnosis of RCLC are discussed. The case highlights the need for circumspection in the diagnosis of the cause of acute abdomen. The current trend favours conservative management of RCLC thus the need for a high index of suspicion is emphasized to avoid unnecessary surgery.

Omental torsion mimicking acute appendicitis in a 7-year-old boy: a case report

BackgroundTorsion of the greater omentum is an uncommon cause of acute abdominal pain. Omental torsion can be divided into primary and secondary. Owing to its nonspecific abdominal pain, preoperative diagnosis is difficult. Ultrasound sonography and abdominal computed tomography scans do not have a major role in preoperative diagnosis. The definite diagnosis is usually made during operation.Case presentationA 7-year-old Persian boy was referred with right lower quadrant pain associated with nausea and vomiting. Laboratory blood tests and urinalysis were requested that revealed normal values. Ultrasonography was performed, revealing inflammatory changes with mild free fluid collection in the interloop. The patient underwent an open appendectomy, confirming a normal appendix with omental torsion. Two days later, he was discharged home without postoperative complications.ConclusionsIn patients with acute abdomen, particularly those with acute appendicitis symptoms, omental torsion should be considered in the differential diagnosis.