Introduction: As the nonoperative management of acute appendicitis becomes more widespread, identifying patients at high risk of appendiceal tumors is increasingly important. This study aimed to clarify the predictive factors of appendiceal tumors before appendectomy. Methods: We retrospectively analyzed 434 patients diagnosed with acute appendicitis who underwent emergency or interval appendectomy. Results: Appendiceal neoplasms were found in 3.9% of patients. Patients with tumors were significantly older (64.4 vs. 49.6 years, p < 0.001). The tumor group exhibited a lower appendicolith incidence (48% vs. 12%, p = 0.011) and larger appendiceal diameters (18.0 vs. 12.3 mm, p < 0.001). Multivariate analysis demonstrated that age ≥60 years, absence of appendicolith, and an appendiceal diameter ≥12 mm were independent risk factors of appendiceal tumors. Among patients who underwent interval appendectomy, only the non-tumor group exhibited significant improvement in appendiceal diameter after nonoperative management (tumor, +1.6 mm vs. no tumor, −3.5 mm, p < 0.001). Conclusions: Advanced age, absence of appendicolith, and an enlarged appendiceal diameter may be significant predictive factors of appendiceal tumors. These factors will aid in the selection of appropriate appendicitis treatment strategies.

Abstract Background: Transvaginal ultrasound (TVUS) is widely used to evaluate right iliac fossa (RIF) pain in women, yet its diagnostic utility in appendicitis remains unclear. This study assessed the impact of TVUS on surgical decision-making and evaluated patient selection consistency between General Surgery and Gynaecology pathways. Methods: A retrospective cohort of 1,445 women aged ≥16 who underwent urgent TVUS at a single institution (2018–2022) was analysed. Follow-up or incomplete reports were excluded. TVUS findings, blood investigations, and histology results were reviewed. Positive TVUS findings were defined as free fluid or appendicitis (excluding gynaecological pathology). Statistical analyses examined the relationship between TVUS results, surgical intervention, and histological outcomes. Results: Of the cohort, 825 patients were admitted under General Surgery and 620 under Gynaecology. Positive TVUS findings were more frequent in the Gynaecology cohort (48.0% vs. 34.5%, P &lt; 0.00001). However, TVUS positivity did not significantly influence surgical decisions (OR 1.01, 95% CI 0.69–1.46, P = 0.97) or confirm appendicitis histologically (OR 0.50, 95% CI 0.20–1.20, P = 0.130). By contrast, abnormal blood results strongly predicted appendicitis (OR 2.96, 95% CI 1.07–9.09, P = 0.043). Conclusion: TVUS has limited utility in the General Surgery pathway and should not be routinely performed in patients with abnormal blood results. Patients with normal bloods, unlikely to have appendicitis, should instead be referred to Gynaecology, where TVUS better identifies gynaecological pathology. Diagnostic strategies should prioritise blood tests and alternative imaging to enhance patient outcomes.

Background: Laparoscopic appendectomy is the preferred treatment for acute appendicitis, but conversion to open laparotomy is sometimes necessary. Identifying risk factors for conversion is crucial for surgical planning, patient counseling, and optimizing outcomes. This study aimed to determine the patient, disease, and intraoperative factors associated with conversion from laparoscopic to open appendectomy. Methods: A retrospective observational study was conducted on 250 patients who underwent laparoscopic appendectomy for acute appendicitis at a single institution between January 2020 and January 2025. Data on demographic characteristics, comorbidities, disease severity, and intraoperative findings were collected from medical records. Statistical analyses, including univariate and multivariate logistic regression, were used to identify independent risk factors for conversion. Results: The conversion rate to laparotomy was 12% (30/250). Significant patient-related risk factors included advanced age (mean 41.2 vs. 31.5 years, p&lt;0.05), male gender (83.3% vs. 56.8%, p&lt;0.05), obesity (BMI &gt;30; 60% vs. 28.2%, p&lt;0.01), and a history of prior abdominal surgery (40% vs. 15%, p&lt;0.01). Disease severity was a strong predictor, with significantly higher conversion rates for gangrenous (40% vs. 21.8%) and perforated appendicitis (40% vs. 17.2%), and particularly for abscess formation (50% vs. 9.1%, p&lt;0.001). Key intraoperative factors leading to conversion were dense adhesions (50% vs. 11.4%, p&lt;0.001), unclear anatomy (43.3% vs. 6.8%, p&lt;0.001), and excessive bleeding (33.3% vs. 4.5%, p&lt;0.001). Conversion was associated with worse outcomes, including higher complication rates (26.7% vs. 6.8%, p&lt;0.01) and longer hospital stays (6.5 vs. 3.2 days, p&lt;0.001). Conclusion: Conversion to laparotomy is influenced by a combination of patient-related factors (age, gender, obesity, surgical history), disease severity (gangrenous/perforated appendicitis, abscess), and intraoperative challenges (adhesions, unclear anatomy, bleeding). Recognizing these risk factors preoperatively can enhance surgical preparedness and patient counseling. Conversion should be viewed as a prudent decision to ensure patient safety rather than a procedural failure.

Laparoscopic appendectomy has become the standard treatment for acute appendicitis. However, surgical site infections still occur in up to 8% of patients. The aim of this review was to compare the short- and long-term outcomes of an intraumbilical incision with a periumbilical incision for umbilical port placement in laparoscopic appendectomy. A systematic literature search for randomized clinical trials (RCTs) was performed in CENTRAL, PubMed, Embase, and Web of Science (last search 10 January 2025). Four outcome variables provided sufficient data to allow for a meta-analysis using the random-effects model. Risk of bias (Cochrane 2.0) and certainty of evidence (GRADE) were assessed. Six RCTs from Asia with 1576 patients were included. An intraumbilical incision may have little to no effect on operation time (MD -1.57min, 95%-CI: -5.30 to 2.16, p=0.41, I2=98%, and GRADE=very low) and length of hospital stay (MD 0.17days, 95%-CI: -1.12 to 1.47, p=0.79, I2=93%, and GRADE=very low). Moreover, the evidence suggests that an intraumbilical incision may result in little to no difference in internal organ injury (OR 0.69, 95%-CI: 0.33 to 1.43, p=0.32, I2=0%, and GRADE=low) and umbilical surgical site infection (OR 0.76, 95%-CI: 0.40 to 1.44, p=0.40, I2=22%, and GRADE=low). Five RCTs were assessed as having a high risk of bias, whereas one study raised some concerns. The evidence suggests that there is little to no difference in any of the clinical short-term outcomes between intraumbilical and periumbilical port placement in laparoscopic appendectomy. Surgeons should use their preferred approach. The body of evidence would benefit from a high-quality RCT in a western population and from data on long-term outcomes. CRD42025628000 (PROSPERO).

BACKGROUND:This study aimed to evaluate the efficacy of conservative management as an alternative to surgery in treating acute uncomplicated appendicitis, a common surgical emergency worldwide. MATERIALS AND METHODS: This prospective cross-sectional study was conducted in the surgical unit at Medical Teaching Institute/Mardan Medical Complex from May to October 2024. Using non-probability convenient sampling, 140 patients were included, as determined by the WHO sample size calculator (5% margin of error). Participants with acute uncomplicated appendicitis (Alvarado score &gt;5) were identified through clinical history, physical examination, and laboratory tests. Exclusions included patients with recurrent appendicitis or complicated cases involving perforation, abscesses, or peritonitis. RESULTS: A total of 140 patients with acute uncomplicated appendicitis were included in the study, comprising 83 (59.3%) males and 57 (40.7%) females. The age distribution was as follows: &lt;20 years (8.6%), 20–30 years (47.9%), 31–40 years (30.7%), and &gt;40 years (12.9%), with a mean age of 29.4 ± 7.9 years. The mean duration of symptoms at presentation was 13.9 ± 8.2 hours. All patients received intravenous antibiotics, analgesics, and fluids for at least 48 hours. Conservative management was successful in 87 (62.1%) patients, while 38 (27.1%) experienced treatment failure, and 15 (10.7%) had recurrent acute appendicitis. CONCLUSION: Our study underscores the effectiveness of conservative management in acute uncomplicated appendicitis, with a success rate of 62.1% using intravenous antibiotics, analgesics, and fluids. While 27.1% of patients required surgery due to treatment failure and 10.7% experienced recurrence, most avoided immediate surgical intervention. This approach not only proves clinically effective but also offers substantial cost benefits.

Antibiotics are safe and efficient for CT-diagnosed uncomplicated acute appendicitis. Identifying predictive factors of primary non-responsiveness or recurrence would further improve antibiotic treatment success and safety. All patients treated with antibiotics in two large RCTs (APPAC and APPAC II) were included. The primary non-responsiveness analysis compared patients operated on within 30 days after randomization for complicated appendicitis with either patients presenting with uncomplicated appendicitis at surgery within 30 days or patients with successful antibiotic treatment during 3-year follow-up. Prognostic factors for appendicitis recurrence were assessed by comparing patients with successful antibiotic treatment with patients with acute appendicitis operated on after 30 days of initial antibiotics. Of 856 patients randomized to antibiotics (mean(s.d.) age of 36(12) years; 365 (42.6%) were women), 832 were eligible for non-responsiveness analysis and 732 for appendicitis recurrence analysis. Findings associated with primary non-responsiveness on admission included an appendiceal diameter ≥15 mm (adjusted risk ratio (RR) 4.00 (95% c.i. 2.00 to 7.92) (P < 0.001)) and a body temperature >38°C (adjusted RR 2.76 (95% c.i. 1.27 to 6.03) (P = 0.011)). During the first 6-30 h after admission, C-reactive protein (CRP) ≥100 mg/l (negative predictive value of 99%) and leucocyte count ≥9 × 109/l were associated with primary non-responsiveness (adjusted RR 8.29 (95% c.i. 3.69 to 18.63) (P < 0.001) and adjusted RR 4.44 (95% c.i. 1.79 to 11.05) (P = 0.001) respectively). No prognostic findings for appendicitis recurrence were identified. Patients with an appendiceal diameter ≥15 mm and a body temperature >38°C may not be optimal candidates for non-operative treatment for uncomplicated acute appendicitis. Patients with CRP <100 mg/l at 24 h of antibiotic treatment for uncomplicated acute appendicitis have a 99% likelihood of successful antibiotic therapy. NCT03236961 and NCT01022567 (http://www.clinicaltrials.gov).

INTRODUCTION: Today, laparoscopic appendectomy (LAE) is the ‘golden standard’ of the treatment for acute appendicitis. However, the choice of the method of management of the appendix stump (AS) causes much debate. AIM: Comparative analysis of invagination and ligation methods of management of the appendix stump in LAE. MATERIALS AND METHODS: The analysis included data from 130 patients who underwent LAE. An analysis and comparison of the invagination and ligation methods of management of AS are presented. RESULTS: There were no significant differences in the frequency of mild postoperative complications of LAE, severity of pain syndrome and length of hospital treatment. The difference was in the time of the surgical intervention, which was longer in the group of patients with AS managed using the invagination method. The frequency of infiltrates of the right iliac fossa was lower in the group of AS management using invagination method. CONCLUSION: This clinical study demonstrated the effectiveness, safety and availability of the invagination method of AS management compared to the ligation method. A disadvantage of the invagination method is the requirements to the surgeon’s practical skills and a significant increase in the length of the operation. The management of the AS by immersing it with the intracorporal suture into the cecum cupula can be recommended for use in the everyday surgical practice.

Objective: To analyze the effects of combined spinal-epidural anesthesia and epidural anesthesia in patients undergoing appendicitis surgery. Methods: Seventy-eight patients who underwent surgical treatment for appendicitis from February 2022 to February 2025 were selected as samples and randomly divided into two groups. The study group received combined spinal-epidural anesthesia, while the control group received epidural anesthesia. Anesthesia indicators, vital signs, and complication indicators were compared between the two groups. Results: The onset time of anesthesia in the study group was shorter than that in the control group, the visual analog scale (VAS) score was lower than that in the control group, and the highest plane of anesthesia block was lower than that in the control group (P &lt; 0.05). At 15 minutes after anesthesia induction and at the end of surgery, the heart rate (HR), mean arterial pressure (MAP), and blood oxygen saturation (SPO2) in the study group were significantly different from those in the control group (P &lt; 0.05). The complication rate in the study group was lower than that in the control group (P &lt; 0.05). Conclusion: Combined spinal-epidural anesthesia for appendicitis surgery can reduce the impact of anesthesia on vital signs, shorten the onset time of anesthesia, and is highly effective and feasible.

Objective:To observe the clinical effect of fast-track surgery on laparoscopic treatment of pediatric acute appendicitis and its effect on abdominal inflammation and stress level.Methods:This was a clinical comparative study. Ninety children admitted to Baoding Hospital, Beijing Children’s Hospital Affiliated to Capital Medical University from July 2022 to December 2023 for laparoscopic appendectomy were randomly divided into the control group and the experimental group(n=45 in each group). The control cohort received routine perioperative nursing care, whereas the experimental cohort received fast-track surgery during the same perioperative period. Postoperative complications, including abdominal distension, nausea, vomiting, urinary tract infection, poor incision healing, were compared between the two cohorts. Evaluated the contrasts in stress biomarkers, including TNF α, IL-6, CRP, and serum cortisol (cort), as well as pain symptoms and satisfaction levels between the control and experimental cohorts.Results:The experimental cohort exhibited considerably shorter postoperative exhaust time, feeding time, getting out-of-bed time, and hospital stay compared to the control cohort, with statistically meaningful contrast(P=0.00). At 12 and 24 hours after surgery, the VAS scores in the experimental cohort were considerably lower than those in the control cohort, with a statistically meaningful contrast(P=0.00). Furthermore, the nursing satisfaction rate in the experimental cohort was considerably higher than in the control cohort, with a statistically meaningful contrast (P=0.02).Conclusion:Fast-track surgery boasts a variety of benefits in the perioperative period of laparoscopic treatment of pediatric acute appendicitis, such as effectively shortening postoperative recovery time and hospital stay, reducing the occurrence of complications.

Laparoscopic surgery has emerged as the preferred treatment for acute appendicitis, a common acute abdominal condition. Despite surgical advances, postoperative gastrointestinal dysfunction and delayed recovery continue to negatively impact rehabilitation outcomes and patient quality of life. Laser acupuncture represents a promising emerging complementary therapy with potential benefits for promoting functional recovery. To evaluate the clinical efficacy of laser acupuncture in enhancing gastrointestinal function recovery following laparoscopic appendectomy and to investigate its potential applications in postoperative rehabilitation. This retrospective controlled clinical study selected 120 acute appendicitis patients who underwent laparoscopic appendectomy from January 2022 to December 2023 at a tertiary hospital. Patients were randomly divided into two groups: Routine treatment group (n = 60) and laser acupuncture intervention group (n = 60). There were no significant statistical differences in baseline characteristics (age, gender, body mass index, appendicitis severity) between the two groups. The routine treatment group received standard postoperative care, while the laser acupuncture intervention group received additional laser acupuncture treatment on top of standard care. Key observation indicators included time to first exhaust, time to first bowel movement, time to gastrointestinal function recovery, and postoperative complication rates. Patients in the laser acupuncture intervention group showed significantly faster gastrointestinal function recovery compared to the routine treatment group. Specifically, time to first exhaust was significantly shortened (intervention group: 12.5 ± 2.3 hours vs control group: 18.7 ± 3.1 hours, P < 0.05), time to first bowel movement was earlier (intervention group: 36.4 ± 4.6 hours vs control group: 48.2 ± 5.7 hours, P < 0.05), postoperative complication rate was significantly reduced (intervention group: 8.3% vs control group: 20.0%, P < 0.05), postoperative pain score was significantly lower (intervention group: 3.2 ± 1.1 vs control group: 4.7 ± 1.5, P < 0.05), and intestinal motility recovery was faster and more effective. Laser acupuncture, as an auxiliary treatment method, can significantly promote gastrointestinal function recovery in patients after laparoscopic appendectomy, reduce complications, and improve postoperative comfort. This technique has advantages such as minimal invasiveness, rapid recovery, and few side effects, making it worthy of further clinical promotion and application.

The negative appendectomy rate is the rate of a normal appendix that is diagnosed histologically.It is an indicator of the diagnosis and treatment of acute appendicitis to prevent complications like perforation or abscess formation.In this review, we will look at the predictive factors for negative appendectomy, the role of pre-operative imaging in reducing the negative appendectomy rate, and the role of laparoscopic appendectomy in reducing this rate.

Comment on “While the Laparoscopic Appendectomy Is the Gold Standard in the Treatment of Acute Appendicitis, What Should Be the Preference for Closure of the Appendix Stump?”

BackgroundAcute appendicitis is a common abdominal surgical emergency and is a major cause of acute abdomen in more than 20% of cases. Although various studies have been conducted in recent years on topics such as surgical techniques and antibiotic treatment of appendicitis, today there is a lack of large-scale studies focused on the different severity levels of acute appendicitis and their management. The study aimed to analyze the severity, types of surgical techniques, and mortality associated with acute appendicitis to identify possible developments.MethodsWe conducted a retrospective multicenter observational study based on routine data from 2010 to 2022. Patients over 18 years old with acute appendicitis were included and the following data were collected: patient demographics, comorbidities, type of surgery, complications, admission to ICU, length of stay, and in-hospital mortality. A total of 31,988 patients were included in the study.ResultsAt the end of the study, 97.0% (P < .001) of the patients underwent laparoscopic appendectomy, with 86% of cases involving closure of the appendix stump by stapler (P < .001). It was only from 2014 onwards that more than 90% of surgeries were performed laparoscopically, and from 2017, this figure rose to 95%. Complicated appendicitis was present in 27.4% of cases. The distribution of severity was as follows: unspecified acute appendicitis in 39.5%, appendicitis with local peritonitis in 33.1%, appendicitis with local peritonitis and perforation in 17.1%, appendicitis with peritoneal abscess in 5.4%, and appendicitis with generalized peritonitis in 4.9%. Women had a significantly lower risk for conversion to an open operation than men (P < .001). The highest morbidity was observed in the group that converted from laparoscopy to open surgery (P <.001). Non-surgical treatment of appendicitis was not relevant, accounting for only 4% of cases.ConclusionSince 2017, primary laparoscopic appendectomy has been the gold standard for even complicated acute appendicitis (> 95% annually). Over three-quarters of patients undergo an appendectomy with a stapler, making this surgical technique the preferred method of laparoscopic surgery in Germany. Patients who undergo an interoperative switch to open therapy should be considered a subgroup at risk of increased mortality.Trial registrationClinicalTrials.gov ID: NCT06558760.

Endoscopic direct-vision appendicitis therapy for the treatment of chronic appendicitis with multiple appendicoliths

Background: The simultaneous surgical treatment of acute appendicitis and inguinal hernia in children is still controversial. However, there are no established guidelines for the simultaneous surgical treatment of pediatric patients with acute appendicitis and inguinal hernia. The aim of this study is to evaluate the safety and efficacy of a simultaneous laparoscopic approach for acute appendicitis and inguinal hernia in a pediatric population. Methods: The case records of 2254 pediatric patients who underwent appendectomy at our institution between 1 January 2012 and 1 January 2025 were reviewed. Finally, 44 patients who met the inclusion criteria and had an inguinal hernia at the time of laparoscopic appendectomy were selected for further analysis. The patients who underwent single-stage surgery (simultaneous laparoscopic appendectomy and hernia repair) were assigned to group I (n = 25), while the patients who underwent delayed laparoscopic hernia repair were assigned to group II (n = 19). The groups were compared for final outcome, complications, rate of readmissions within 30 days of index surgery, duration of surgery, and length of hospital stay. Results: The mean age of all the included patients was 11.5 ± 4.0 years, with males slightly outnumbering females (n = 25, 56.8%). The study population consisted of two comparable groups in terms of age, anthropometric measures, gender distribution, and baseline clinical characteristics. A major difference between the two methods was the operation time, which was significantly longer in the single-stage group (53.5 ± 11.2 min vs. 41.5 ± 10.9 min; p = 0.001). Despite the difference in operative time, the length of hospital stay (3.5 ± 2.0 days vs. 3.5 ± 2.2 days; p = 0.899) was almost identical between the two groups, suggesting that the additional intraoperative time was not reflected in a prolonged recovery time. In addition, postoperative complications were rare and evenly distributed between both surgical strategies (n = 2 (8%) vs. n = 2 (10.5%); p = 0.772). All the complications were minor and were treated conservatively. Importantly, there was no recurrence of hernia in either group during the follow-up period. Conclusions: From a clinical perspective, these results suggest that the single-stage approach is feasible and safe, even in complicated appendicitis, particularly in cases where the postponement of hernia repair is not desirable. The longer operative time associated with the single-stage approach must be weighed against the potential benefits of avoiding a second surgical procedure and unnecessary anesthesia, reducing overall healthcare utilization, and minimizing patient burden.

The negative appendectomy rate is the rate of a normal appendix that is diagnosed histologically. It is an indicator of the diagnosis and treatment of acute appendicitis to prevent complications like perforation or abscess formation. In this review, we will look at the predictive factors for negative appendectomy, the role of pre-operative imaging in reducing the negative appendectomy rate, and the role of laparoscopic appendectomy in reducing this rate.

Laparoscopic appendectomy (LA) is a standard treatment for acute appendicitis (AA), offering reduced complications and improved patient outcomes. However, in certain cases, the need for conversion to open appendectomy (OA) may arise. The present systematic review and meta-analysis aimed to identify preoperative risk factors associated with conversion from LA to OA. The global databases of PubMed, Web of Science, Scopus, and Embase were systematically searched from inception to 20 April 2024. Studies evaluating clinical, laboratory, and imaging risk factors of conversion from LA to OA were assessed for inclusion eligibility. Fixed-effects or random-effects models were utilized to calculate pooled odds ratio (OR) and standard difference in mean (SMD) with a 95% confidence interval (CI), using Comprehensive Meta-Analysis software version 3. The Joanna Briggs Institute Critical Appraisal Checklist was employed to assess the quality of the eligible studies. In total, 45 studies with an overall sample size of 3,202,336 were included for meta-analysis. The conversion rate from LA to OA was 8.7% (95% CI: 7.7%, 9.8%). Conversion was associated with older age, male gender, and comorbidities such as obesity, diabetes, hypertension, and cardiovascular disease. Previous abdominal surgery, prolonged symptom duration, higher Alvarado score, elevated inflammatory markers, and imaging findings (e.g., larger appendiceal diameter and intra-abdominal fluid) were also significant predictors. The present systematic review and meta-analysis identified the most important clinical, laboratory, and imaging factors associated with the conversion from LA to OA, aiding surgeons in perioperative risk stratification and improving patient outcomes. Despite the inclusion of high-quality studies, the majority were retrospective, and the quality of evidence for many risk factors was moderate to low, representing an important limitation. Graphical abstract presented here http://links.lww.com/JS9/E650 .

There has been a sea change in the management of acute appendicitis over the last quarter of a century. This arose from the realisation that with early imaging and clinical scoring systems appendicitis could be diagnosed early and the pathophysiology reversed by the timeous and appropriate administration of intravenous antibiotics. There has been a growing body of literature attesting to the efficacy of antibiotic therapy in the treatment of acute uncomplicated appendicitis.1,2 No less an organisation than the American College of Surgeons has described antibiotic treatment of acute uncomplicated appendicitis as an "accepted first-line therapy."3 The American college came to this conclusion based on a number of randomised trials. Most authors on the topic concur with the college that antibiotic treatment is "not inferior" to appendectomy as based on outcomes, measured up to thirty days.1,2 This has been supported by many clinical audits and reports as well as a number of well-constructed randomised trials.

BACKGROUND: Currently, despite the development of modern technologies, timely diagnosis of acute appendicitis in pregnant women still remains an important task. Early and correct diagnosis makes it possible to determine the necessary tactics and treatment, which minimizes possible complications and negative results of surgical interventions. AIM: The aim of the study was to analyze medical histories and find a new approach in the diagnosis and treatment of acute appendicitis in pregnant women in the second and third trimesters of pregnancy. MATERIALS AND METHODS: A retrospective analysis of medical records of pregnant patients (n=162) operated on with a diagnosis of acute appendicitis in the period from 2010 to 2019 was carried out. The study took into account epidemiological, clinical, paraclinical, operational and postoperative data. Statistical processing of the obtained data was carried out. RESULTS: When conducting a comparative analysis, the most significant predictors of acute appendicitis in pregnant women were identified: the level of leukocytes in the blood ≥12.5×109/l [relative risk (RR) (confidence interval (CI)) 2.37 (1.47–3.80)], C-reactive protein ≥21.0 mg/l [RR (CI) 1.72 (1.36–2.17)], positive Kocher’s sign [RR (CI) 2.01 (1.50–2.69)], and percentage granulocyte count ≥78.0 [RR (CI) 2.2 (1.29–3.77)], and presence of nausea/vomiting [RR (CI) 1.35 (1.03–1.76)]. Based on the obtained data from univariate analysis, a decision tree diagram was developed to determine the risk of developing acute appendicitis. The proposed decision tree diagram has good sensitivity (65.9%) and specificity (92.1%) with AuROC=0.86. CONCLUSIONS: The constructed diagnostic model can be used in clinical practice to determine the likelihood of acute appendicitis in pregnant women in the II–III trimesters of pregnancy, and the inclusion of magnetic resonance imaging can significantly improve the quality of acute appendicitis diagnosis, which requires further research in this direction.

The movement in the high-income countries of the world away from surgery as the mainstay of treatment for acute uncomplicated appendicitis, has been well documented and is supported both in the literature and by several prominent surgical societies, in both North America and Europe.1,2 The proponents of this approach point to the cost savings associated with reduced use of operating theatres and laparoscopic equipment, as well as the prevention of longterm morbidity such as port site hernias and abdominal adhesions.1,2 They also point to the use of antibiotics as firstline therapy in other abdominal emergencies such as acute diverticulitis. In acute diverticulitis antibiotic therapy may abort acute low-grade inflammation and help avoid surgery, which traditionally involves a morbid stoma. The proponents of non-operative management of acute uncomplicated appendicitis point to the many benefits of this approach. The recent Comparison of Antibiotic Drugs and Appendectomy (CODA) trial which randomised 1 552 adult patients with acute uncomplicated appendicitis, to either laparoscopic appendicectomy or antibiotic therapy, concluded that antibiotics were non-inferior to appendectomy based on results of a standard health-status measure. It should be noted that in the antibiotics group, nearly 3 out of every 10 participants had subsequently undergone an appendectomy by 90 days. Also of note is that patients with an appendicolith were at a higher risk for delayed appendectomy and complications than those without an appendicolith.1,2 The authors went on to state that in the antibiotics group, more than 7 in 10 participants avoided surgery, were treated mostly as outpatients and subsequently missed fewer days at work.