To investigate the clinical characteristics of patients with first-episode acute appendicitis and explore the value of CT imaging grading combined with inflammatory markers in evaluating the cure and relapse of conservative treatment. A retrospective cohort study was conducted to collect the clinical data of 482 patients with acute appendicitis diagnosed in the Emergency Department of the Second Affiliated Hospital of Fujian Medical University from October 2021 to February 2024. The imaging features of these patients were evaluated using Computed Tomography (CT) scans. Descriptive analysis, chi-square test, ordinal logistic regression model, Kaplan-Meier curve, and COX regression analysis were used to analyze the data. Elevated levels of Procalcitonin (PCT) and C-Reactive Protein (CRP) were associated with higher CT grades. Acute appendicitis patients with higher CT grades had a poor prognosis with antibiotic treatment. CT grade was a predictor of the prognosis of antibiotic treatment, and a high CT grade was an independent risk factor for relapse. CT grade combined with inflammatory markers (PCT and CRP) can effectively predict the prognosis of conservative treatment for acute appendicitis, and CT grade can be used to predict the risk of relapse.

IntroductionLaparoscopic appendectomy (LA) is the first-line treatment for acute appendicitis. We compared Hem-O-Lok clips (HOL) and endoscopic staplers to evaluate cost savings without compromising outcomes within the San Bernadino service area Kaiser Permanente Health Maintenance Organization.MethodsThis retrospective case-control study included patients ≥6 years who underwent LA (2016-2022) using HOL clips or ES for stump closure. Of 571 patients, 341 used HOL and 230 ES based on surgeon preference. Propensity score matching (1:1) by age, sex, Body Mass Index (BMI), and American Society of Anesthesiologist (ASA) Physical Status Classification yielded 177 pairs. Outcomes included 30-day complications, length of stay, estimated blood loss (EBL), and readmission.ResultsPatients in the HOL group were significantly older, had more comorbidities, had higher BMI values, and classified as ASA II or higher. The diagnosis of acute appendicitis was more frequent in the HOL group (81.3% vs 73.0%) and gangrenous disease more common in ES group (6.1% vs 1.5%). Despite this, there was no increased post-operative complication rates between the two groups. Return to the hospital were similar between the two groups (5.3% vs 7.9%). The cost per ES load is $273 compared to a six pack of HOL clips costing $32.ConclusionHOL clips in LA showed no increase in morbidity, supporting a lower-cost alternative.

Fecalith-associated appendicitis presents unique challenges in conservative management due to increased perforation risk. Early identification of patients at high risk for appendiceal perforation during conservative treatment remains crucial for optimal clinical decision-making. To develop and validate machine learning-based prediction models for appendiceal perforation risk assessment during conservative treatment of fecalith-associated appendicitis. This retrospective cohort study analyzed 1247 patients with fecalith-associated appendicitis who underwent initial conservative treatment across four tertiary care centers between January 2018 and December 2023. The study design and reporting adhere to the TRIPOD (Transparent Reporting of a multivariable prediction model for Individual Prognosis or Diagnosis) guidelines for model development and external validation. Twenty machine learning algorithms were systematically trained and validated using clinical, laboratory, and imaging parameters. LASSO regularization identified eight optimal predictive features from 34 candidate variables. The final nominated model for clinical deployment is the Gradient Boosting classifier, trained on all eight LASSO-selected features. Primary outcome was appendiceal perforation within 72h of conservative treatment initiation. Of 1247 patients, 186 (14.9%) developed appendiceal perforation during conservative treatment. The ensemble gradient boosting model achieved the highest performance with an AUC of 0.892 (95% CI 0.871-0.913), sensitivity of 84.4% (95% CI 79.2-89.6%), and specificity of 81.7% (95% CI 77.8-85.6%). External validation in an independent cohort (n = 225; The People's Hospital of Sishui, January 2023-December 2024) confirmed model generalisability: AUC = 0.909 (95% CI 0.859-0.951), sensitivity = 73.7%, specificity = 93.0%, PPV = 68.3%, and NPV = 94.6%. SHAP analysis identified key predictive features: fecalith size (importance: 0.234), C-reactive protein (0.186), white blood cell count (0.162), appendiceal wall thickness (0.143), and patient age (0.121). Risk stratification classified patients into low-risk (58.9%, 3.8% perforation rate), moderate-risk (31.9%, 24.6% perforation rate), and high-risk (9.2%, 71.3% perforation rate) categories. Decision curve analysis demonstrated significant clinical utility with net benefit of 0.08 at 15% threshold probability. Machine learning models, particularly ensemble gradient boosting methods, demonstrate excellent accuracy in predicting appendiceal perforation risk during conservative treatment of fecalith-associated appendicitis, with performance confirmed in an external validation cohort. These validated models provide clinically actionable risk stratification that may assist in treatment decision-making and patient monitoring strategies, potentially preventing unnecessary surgeries while identifying high-risk patients requiring enhanced surveillance or early surgical intervention.

Plasma sodium as a predictor of perforation in acute appendicitis: A prospective multi-centre study.

Oncologic Implications of Nonoperative Appendicitis Treatment

Appendicectomy remains the gold standard treatment for acute appendicitis. While there is continued debate as to the clinical benefit of conservative treatment in acute appendicitis, the cost-effectiveness of each treatment is a critical consideration. The aim of this study is to evaluate the current health economic evidence for surgery versus conservative management in acute appendicitis. A systematic literature search of 3 online databases for evidence pertaining to the economics of appendectomy compared with conservative management was performed according to PRISMA standards. The study protocol was prospectively registered with PROSPERO (study ID: CRD42023412691). A total of 1219 patients were included (639 operative treatment vs. 580 conservative management). A total of 5 studies were included. Surgery was significantly more expensive when compared with conservative treatment (16.5% to 83.0%) percentage cost difference. The average length of hospitalisation was similar between the groups. The majority of studies reported a 12-month follow-up. The CHEERS assessment revealed a considerable risk of bias. Conservative management of appendicitis is the more economically effective treatment of the 2 modalities. This is an important consideration for resource-limited health care systems. However, further research with standardized methodologies and longer-term follow-up is warranted to fully assess the economic implications and clinical effectiveness of both treatment approaches. Analysis indicates conservative management as the economically preferable option for acute appendicitis over surgery. This finding underscores its potential significance for resource-constrained health care systems. However, standardized studies with extended follow-up in different global health care settings are required to evaluate the economic and clinical merits of both treatment strategies.

CRP/Albumin index as a predictor of complicated appendicitis: beyond clinical signs.

Acute appendicitis is one of the most common surgical emergencies. Emerging evidence suggests uncomplicated appendicitis could be treated by antibiotics. We investigated the outcome of patients treated with antibiotics for acute appendicitis with a three-year follow-up. Secondary aims were to assess recurrence of appendicitis and potential missed pathologies with nonoperative management. All computed tomography (CT) scan reports with keyword 'appendicitis' of adult patients performed from January 2020 to December 2021 were reviewed. Reports were classified as uncomplicated or complicated based on previous definition. Demographic data, treatment information including operative details and complications, and recurrence of antibiotic-treated appendicitis were collected retrospectively. Among 3,252 scans, 1,008 confirmed appendicitis (631 uncomplicated, 377 complicated; median age 46 years). 212 patients (21.0%) were treated with antibiotics and 796 (79.0%) underwent appendicectomy. After excluding deaths, 195 nonoperatively treated patients were available for three-year follow-up: 83 (42.6%) developed recurrence and 57 (29.2%) had surgery. Neoplasms were found in 19 of 591 (3.2%) CT-diagnosed uncomplicated appendicitis. Overall, neoplasms were found in 3.5% of the specimens. Postoperative complications occurred in 11% of all surgeries, of which 2.3% were Clavien-Dindo grade III-V. Antibiotic treatment of appendicitis is associated with high recurrence and risk of missed neoplasms. Appendicectomy is safe, with low rates of significant complication. When offering nonoperative management for appendicitis, patients should be informed about the risk of recurrence and missing sinister pathologies.

Introduction: Appendectomy is done for the treatment of acute appendicitis. Surgical Site Infection is a common postoperative complication. Most of the time, body mass index is measured to determine the presence of obesity. Still, it cannot predict adiposity at the incision site, so subcutaneous fat, which can be measured easily at the incision site, can be a better predictor. This study aimed to find a correlation between subcutaneous fat thickness and superficial surgical site infection in patients undergoing emergency open appendectomy. Methods: This prospective observational study was done from July 2023 to July 2024, including 118 cases with a diagnosis of uncomplicated appendicitis. Ethical approval was taken from the Institutional Review Board (Ref: 534/2080/81). Data were collected as per the proforma and maintained in Microsoft excel. Statistical Package for the Social Sciences version 26 and Pearson correlation were used for statistical analysis. Results: Among 118 patients included, 11 (9.30%) had superficial surgical site infection, which was higher among female patients 6 (12%). The calculated cut-off subcutaneous fat thickness was 2.05 cm in our study. The estimated positive predictive value was 16.99% and the negative predictive value was 98.17% for subcutaneous fat in predicting infection. The receiver operating characteristic curve showed an area under the curve of 0.75, indicating that subcutaneous fat can be used as one of the predictors of superficial SSI infection. Conclusions: Patients with increased subcutaneous fat thickness at the incision site had a higher incidence of surgical site infection. This concluded that increased subcutaneous fat thickness increases the risk of superficial surgical site infection, and that local adiposity at the site of the incision is a good predictor of surgical site infection.

Appendicitis is a common condition typically treated surgically via appendectomy. However, recently there has been increased interest in non-surgical treatment options, such as antibiotics, to avoid risks of surgical complications. This case report describes a non-surgical, Ayurvedic intervention for uncomplicated acute appendicitis (without perforation). A 25-year-old male was admitted to hospital and diagnosed with acute appendicitis. Initial management included a single dose of multiple intravenous medications, including antibiotics, an antiemetic, and a proton pump inhibitor. However, he refused laparoscopic appendectomy. The patient sought an Ayurvedic consultation immediately after discharge from the hospital. The patient was prescribed an herbal regimen, provided with dietary recommendations, and followed-up closely over the following two weeks. The primary outcome measures were visualization and measurement of the appendix via abdominal ultrasound, and pain score (on a scale of 0-10). The patient demonstrated rapid and sustained symptom resolution, with his pain score decreasing from 8 to 0 over two weeks. There was also normalization of diagnostic imaging findings, with the patient's appendix decreasing in size from 9 mm to <4 mm. Overall, this case suggests that Ayurvedic intervention may be useful for treating uncomplicated acute appendicitis as an alternative to surgical intervention, with no adverse effects. However, literature lacks data on the incidence and clinical outcomes of Ayurvedic treatment for appendicitis. Hence, further rigorous studies are needed to investigate the incidence and assess the efficacy of Ayurvedic treatment protocols for uncomplicated acute appendicitis. Ayurveda, acute appendicitis, case report, botanical medicine, nutrition therapy.

The benefits of interval appendectomy (IA) in complicated appendicitis are well known. However, these remain unclear in uncomplicated appendicitis (UA) despite patients with UA often receiving IA in actual clinical situations. This study investigated whether IA is an effective strategy for the treatment of UA. We included Patients diagnosed with UA who underwent laparoscopic surgery between January 2017 and December 2023 were included. We compared the surgical outcomes between the emergency surgery (ES) and IA groups and analyzed 12 factors to identify risk factors for postoperative complications. 263 patients (ES group, N = 161; IA group, N = 102) were enrolled. The rates of any complication, Clavien-Dindo (C-D) grade ≥ I, and severe complication, C-D grade ≥ III, were similar (P = 0.38, P = 0.26) in both groups. In contrast, the total length of hospital stay was shorter in the ES group (P < 0.001). Among the 263 patients, postoperative complications of any type were observed in 14 (5.3%). A multivariate analysis identified no independent risk factors for postoperative complications including ES. The surgical outcomes of ES in patients with UA were favorable. Therefore, the benefits of IA are minimal and it may not be the first therapeutic choice for UA.

Background:Laparoscopic appendectomy (LA) is the conventional treatment for chronic appendicitis. Endoscopic direct-vision appendicitis therapy (EDAT) has emerged as a minimally invasive, organ-preserving alternative.Objectives:To compare the efficacy and safety of EDAT versus LA in chronic appendicitis.Design:Multicenter retrospective cohort study with propensity score matching (PSM).Methods:This multicenter retrospective cohort study was conducted in China between January 2019 and February 2024. PSM was performed to minimize selection bias. A total of 186 patients with chronic appendicitis were included, including 63 who received EDAT and 123 who underwent LA. The primary outcome was the clinical success rate. The secondary outcomes included the technical success rate, duration of hospitalization, adverse event rate, and recurrence rate.Results:Compared with LA, EDAT showed comparable clinical success (95.2% vs 100%, p = 0.068) and technical success rates (96.8% vs 98.4%, p = 0.877). EDAT reduced the duration of hospitalization (median 2 vs 3 days, p < 0.001) and short- and long-term overall adverse event rates (6.4% vs 45.5% and 7.9% vs 21.1%, respectively; p < 0.001, p = 0.022). At 6, 24, and 48 h postoperatively, the EDAT group had a greater proportion of patients with no pain or mild pain than the LA group did (68.3% vs 40.7% and 90.5% vs 66.7% and 98.4% vs 74.8%, respectively; all p < 0.001). After the 1-year follow-up, the calculated recurrence rate did not differ between the groups (4.8% vs 0%, p = 0.068).Conclusion:Compared with LA, EDAT is a safe, effective, organ-preserving alternative technique for chronic appendicitis, offering a shorter recovery time, reduced adverse event rates, and a low recurrence rate observed during follow-up.

Background and aim Acute appendicitis (AA) is one of the most common surgical emergencies and serves as a key indicator of diagnostic proficiency among medical trainees. Variability in clinical presentations, the occurrence of atypical cases, and the ongoing evolution of diagnostic and management strategies can pose significant challenges for undergraduate medical students, particularly those with limited clinical exposure. This study aimed to assess the knowledge and applied clinical reasoning of fifth- and sixth-year medical students regarding the diagnosis and management of AA. The primary objective was to evaluate students' understanding of classical and atypical clinical presentations, diagnostic approaches, complications, and management strategies. The secondary objective was to identify educational and exposure-related factors associated with variations in knowledge levels. Methods A cross-sectional study was conducted from April to August 2025, targeting fifth- and sixth-year medical students at Al-Qunfudhah Medical College. Using universal sampling, a semistructured questionnaire collected sociodemographic data and included 28 questions assessing knowledge and clinical skills related to appendicitis. Data were analyzed using IBM SPSS Statistics for Windows, Version 28.0 (Released 2021; IBM Corp., Armonk, NY, USA). Results A total of 100 medical students from Al-Qunfudhah Medical College participated; most were under 24 years of age (55%) and male (63%). Fifth-year students comprised 60% of the sample. Nearly half of the participants (48%) had encountered 10-20 appendicitis cases during clinical rotations. Participants demonstrated strong recognition of key clinical features, including continuous sharp pain (81%), periumbilical pain migration (77%), and right lower quadrant localization (74%). Knowledge gaps were identified in recognizing atypical presentations (56%) and pregnancy-related pain variations (56%). Awareness of diagnostic tools was highest for CT scans (86%) and inflammatory markers (69%), while knowledge of ultrasound (62%) and MRI (57%) was moderate. Students demonstrated good understanding of complications such as bleeding (91%) and abscess formation (83%) but showed less awareness of peritonitis (58%). While 76% preferred surgical management, only 55% supported medical management options. Overall, 49% demonstrated moderate knowledge, 24% high knowledge, and 27% low knowledge. Clinical exposure correlated significantly with higher knowledge levels (p = 0.049), whereas age, sex, and year of study showed no significant associations. Conclusions This study demonstrates that medical students at Al-Qunfudhah Medical College have satisfactory knowledge of the classical features and surgical treatment of appendicitis. However, gaps remain in their understanding of atypical presentations, diagnostic tools, and preoperative complications. While students were able to identify common symptoms and postoperative risks, their knowledge was less consistent when applied to varied clinical scenarios encountered in real-world settings.

Abstract Background: Appendicitis is the most common surgical cause of abdominal pain worldwide. Early diagnosis of appendicitis is critical to avoid complications that may be fatal. Appendicitis occurs commonly between the ages of 10 and 30 years. This study aims to assess the levels of awareness and knowledge about acute appendicitis amongst the public in the Al-Baha region, Saudi Arabia. Methods: This cross-sectional study employed a convenience sampling approach; a pilot study was conducted prior to distributing the questionnaire via social media. The three-section tool assessed sociodemographic, appendicitis knowledge and awareness. Data were analysed and descriptive statistics (frequencies/percentages) and Chi-square tests were utilised. Results: A total of 604 participants were included in this study. Four hundred and ten (67.9%) of the participants were male participants, 156 (25.8%) of the participants were 45–54 years old. Participants demonstrated strong awareness of appendicitis symptoms, treatment and complications. Critical knowledge gaps emerged in diagnostic imaging (42.1%), post-symptom dietary safety (25.7%) and preventability (24.2%). Older participants outperformed younger counterparts in understanding aetiology ( P &lt; 0.001), complications ( P = 0.04) and post-operative recovery ( P = 0.005). Conversely, younger participants better identified the high-risk demographic ( P = 0.002). These findings highlight pronounced age-related disparities, with older groups excelling in pathophysiology and management, while younger individuals demonstrated superior epidemiologic awareness. Conclusion: Al-Baha residents demonstrated strong awareness of appendicitis symptoms, treatment and complications, but critical gaps persisted in diagnostic imaging, dietary safety and preventability. Targeted education is needed to address these gaps.

The new edition of the clinical guidelines, developed by leading specialists of the Russian Association of Pediatric Surgeons (RADH), contains updated information on the treatment and diagnosis of the disease in accordance with the latest advances in emergency abdominal surgery. The recommendations are based on the results of completed domestic and international evidence-based studies, including systematic and randomized clinical trials. For diagnosis in a specialized surgical hospital, in addition to routine clinical and laboratory examination, the following are recommended as the main method of mandatory noninvasive instrumental diagnosis: ultrasound examination of the abdominal cavity; dynamic follow-up for doubtful diagnosis of acute appendicitis lasting up to 12 hours, followed by diagnostic laparoscopy. In the presented edition, the issues of classification of acute appendicitis and peritonitis in children are considered in detail. The main complicated forms are appendicular infiltrate, appendicular peritonitis (AP) and periappendicular abscess. It is not recommended to divide the appendicular infiltrate into forms. Conservative treatment with subsequent intervertebral appendectomy is recommended for appendicular infiltration. The division of appendicular peritonitis into forms is supported, depending on the prevalence of the inflammatory process in the abdominal cavity. The division of the periappendicular abscess into 3 stages is substantiated. The issues of surgical access, washing and drainage of the abdominal cavity are considered in detail, depending on the form of appendicular peritonitis and the stage of the periappendicular abscess. For the first time, material on the accumulated global experience in the conservative treatment of acute appendicitis in children is presented and the possibility of conducting such studies in large scientific centers after approval and approval by the RADH is considered. The issues of preoperative preparation, postoperative management and rehabilitation of patients with severe appendicular peritonitis are considered. The publication is intended for practicing pediatric surgeons, anesthesiologists, intensive care physicians, pediatricians and specialists in related specialties, as well as residents and graduate students of relevant fields.

Background In acute appendicitis, while operative management (OM) remains standard, non-operative management (NOM) with antibiotics is an alternative, especially in the elderly population. However, elderly NOM evidence is limited. Aim This scoping review explored the efficacy and safety of NOM compared with OM for acute, uncomplicated appendicitis in elderly patients (≥65 years), identified gaps in the literature, and proposed evidence-based recommendations to guide future research. Methods Following PRISMA Scoping review guidelines, we applied the Population, Concept, and Context (PCC) framework for criteria definition. PubMed and Embase were searched, and Covidence facilitated study selection. The primary outcome was 30-day post-treatment complication, and the secondary outcomes were treatment success (90 days and 1 year), readmission (at 30- and 90-day), and hospital stay (median duration). Risk of bias was assessed using the Newcastle–Ottawa Scale. Results Of 770 records identified, four retrospective cohort studies conducted in the United States met inclusion criteria, with sample sizes ranging from 2,640 to 474,845 elderly patients (≥65 years) with uncomplicated appendicitis. Methodological quality was moderate to high (Newcastle–Ottawa Scale scores 6–8.5). Frailty was variably assessed across studies, and only two stratified outcomes by frailty status. In the largest included study (Ashbrook et al., 2024), overall complication rates were similar between non-operative management (NOM) and operative management (OM) (37.7% vs 36.4%); however, complication rates increased markedly with frailty (28.8% in non-frail vs 57.1% in frail patients). In frailty-stratified analyses, operatively managed patients experienced higher complication rates than those managed non-operatively within both frail (66.3% vs 33.7%) and non-frail (69.8% vs 30.2%) groups. NOM success rates ranged from 62% to 82% but were generally associated with longer hospital length of stay, particularly when NOM failed or surgery was delayed. Estimated readmission following NOM was approximately 20%, primarily due to symptom recurrence or treatment failure. Reporting of antibiotic regimens and follow-up periods was inconsistent across studies. Conclusions Current evidence comparing non-operative and operative management of uncomplicated appendicitis in elderly patients is limited to observational data and demonstrates heterogeneous outcomes. While overall complication rates may appear similar at the population level, frailty substantially modifies treatment-related risk, with higher complication rates observed among operatively managed patients within frailty strata. Non-operative management can achieve acceptable short-term success in selected patients but is associated with longer hospital stays and increased readmission rates. These findings underscore the importance of incorporating standardized frailty assessments into clinical decision-making and highlight the need for prospective studies and randomized trials specifically designed for frail older adults.

Background:Laparoscopic appendectomy (LA) is the preferred treatment for acute appendicitis; however, it still presents a risk of complications such as infection and bleeding. Improper closure of the appendiceal stump can contribute to the development of postoperative complications. This study evaluates the efficacy of a novel buttress technique using the ileocecal fold of Treves to reinforce the staple-line closure of the appendiceal stump.Study Design:We conducted a retrospective cohort study involving 351 patients who underwent LA between 2022 and 2024 at 2 hospitals. Patients were divided into 2 groups: those who received the fold of Treves buttress technique (n = 90) and those who underwent standard staple closure (n = 261).Results:Our results demonstrate that using the fold of Treves buttress technique for securing the appendiceal stump during LA results in favorable outcomes, particularly in postoperative complication rates and length of stay for cases of perforated appendicitis.Conclusions:The use of autologous tissue in this technique offers a cost-effective alternative to commercial buttress materials with the potential to improve patient outcomes in LA. Further studies are necessary to validate these findings and assess the broader applicability of this technique.

Are antibiotics an effective initial treatment for acute appendicitis compared to appendectomy?

Appendicitis is a common surgical emergency affecting people of diverse ages and frequently requires surgical intervention. Guidelines recommend appendectomy as the preferred treatment, and it can be done through laparoscopic or open approach. While both techniques have been well-studied worldwide. However, there have been few studies conducted specifically in Saudi Arabia. In this comprehensive review, we included 22 articles. The articles came from different cities and centers across Saudi Arabia, focusing on outcomes of open and laparoscopic appendectomies. Our results show that laparoscopic appendectomy is safe and effective. Patients who undergo this approach usually recover faster, go home from the hospital sooner, and have fewer complications afterward compared to traditional open surgery. However, some studies in our review suggest that both techniques might be equally effective in certain situations. In conclusion, our findings support laparoscopic appendectomy as a safe and effective treatment for acute appendicitis in Saudi Arabia.

A Follow-up of an Outpatient Laparoscopic Appendectomy Protocol at a Tertiary Care Military Hospital.