1
|
Cao X, Geng X, Zhang C, Chen J, Zhang C, Liu Q, Wu T, Li L. Effect of instant surgery compared with traditional management on paediatric complicated acute appendicitis post-surgery wound: A meta-analysis. Int Wound J 2023; 20:2964-2972. [PMID: 36965159 PMCID: PMC10502279 DOI: 10.1111/iwj.14163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 02/27/2023] [Accepted: 03/07/2023] [Indexed: 03/27/2023] Open
Abstract
A meta-analysis study to assess the influence of instant surgery (IS) compared with conservative therapy (CT) on paediatric complicated acute appendicitis (CAA) post-surgery wounds. A comprehensive literature examination until January 2023 was implemented, and 2098 linked studies were appraised. The picked studies contained 66 674 subjects with paediatric CAA post-surgery wounds in the picked studies' baseline; 64 643 of them were using IS, and 2031 were using CT. The odds ratio (OR) in addition to 95% confidence intervals (CIs) were used to calculate the consequence of the IS compared with the CT on paediatric CAA post-surgery wounds using the dichotomous and continuous styles and a fixed or random model. The IS had a significantly higher wound infection (OR, 4.97; 95% CI, 2.35-10.54, P < .001) with moderate heterogeneity (I2 = 57%) compared with the CT in a paediatric CAA post-surgery wound. However, no significant difference was found between IS and CT in total antibiotic duration (MD, -5.34; 95% CI,-12.67 to -1.98, P = .15) with high heterogeneity (I2 = 95%) in paediatric CAA post-surgery wounds. The IS had a significantly higher wound infection; however, no significant difference was found in total antibiotic duration compared with the CT in paediatric CAA post-surgery wounds. Although precautions should be taken when commerce with the consequences because most of the studies picked for this meta-analysis had low sample sizes.
Collapse
Affiliation(s)
- Xiansheng Cao
- Department of Gastrointestinal Surgery, Hernia and Abdominal Wall Surgery ⅠYantai Affiliated Hospital of Binzhou Medical UniversityShandongChina
| | - Xuejing Geng
- Department of PediatricsYantai Affiliated Hospital of Binzhou Medical UniversityShandongChina
| | - Chunlei Zhang
- Department of Colorectal and Anus SurgeryYantai Affiliated Hospital of Binzhou Medical UniversityShandongChina
| | - Jun Chen
- Department of Gastrointestinal Surgery, Hernia and Abdominal Wall Surgery ⅠYantai Affiliated Hospital of Binzhou Medical UniversityShandongChina
| | - Chao Zhang
- Department of Gastrointestinal Surgery, Hernia and Abdominal Wall Surgery ⅠYantai Affiliated Hospital of Binzhou Medical UniversityShandongChina
| | - Qi Liu
- Department of Gastrointestinal Surgery, Hernia and Abdominal Wall Surgery ⅠYantai Affiliated Hospital of Binzhou Medical UniversityShandongChina
| | - Tianyu Wu
- Department of Gastrointestinal Surgery, Hernia and Abdominal Wall Surgery ⅠYantai Affiliated Hospital of Binzhou Medical UniversityShandongChina
| | - Lei Li
- Department of Gastrointestinal Surgery, Hernia and Abdominal Wall Surgery ⅠYantai Affiliated Hospital of Binzhou Medical UniversityShandongChina
| |
Collapse
|
2
|
Saukhat O, Mushailov A, Kleinbaum Y, Barash Y, Klang E, Nachmany I, Horesh N. Ultrasound-Tomographic Image Fusion - A Novel Tool for Follow up After Acute Complicated Appendicitis. Surg Innov 2023. [PMID: 36866417 DOI: 10.1177/15533506231161122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/04/2023]
Abstract
BACKGROUND Computerized tomography (CT) is an integral part of the follow-up and decision-making process in complicated acute appendicitis (AA) treated non-operatively. However, repeated CT scans are costly and cause radiation exposure. Ultrasound-tomographic image fusion is a novel tool that integrates CT images to an Ultrasound (US) machine, thus allowing accurate assessment of the healing process compared to CT on presentation. In this study, we aimed to assess the feasibility of US-CT fusion as part of the management of appendicitis. MATERIALS AND METHODS We retrospectively collected data of consecutive patients with complicated AA managed non-operatively and followed up with US Fusion for clinical decision-making. Patients demographics, clinical data, and follow-up outcomes were extracted and analyzed. RESULTS Overall, 19 patients were included. An index Fusion US was conducted in 13 patients (68.4%) during admission, while the rest were performed as part of an ambulatory follow-up. Nine patients (47.3%) had more than 1 US Fusion performed as part of their follow-up, and 3 patients underwent a third US Fusion. Eventually, 5 patients (26.3%) underwent elective interval appendectomy based on the outcomes of the US Fusion, due to a non-resolution of imaging findings and ongoing symptoms. In 10 patients (52.6%), there was no evidence of an abscess in the repeated US Fusion, while in 3 patients (15.8%), it significantly diminished to less than 1 cm in diameter. CONCLUSION Ultrasound-tomographic image fusion is feasible and can play a significant role in the decision-making process for the management of complicated AA.
Collapse
Affiliation(s)
- Olga Saukhat
- Department of Diagnostic Imaging, 26744Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel.,Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Avital Mushailov
- Department of Diagnostic Imaging, 26744Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel.,Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yeruham Kleinbaum
- Department of Diagnostic Imaging, 26744Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel.,Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yiftach Barash
- Department of Diagnostic Imaging, 26744Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel.,Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Eyal Klang
- Department of Diagnostic Imaging, 26744Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel.,Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ido Nachmany
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of General Surgery and Transplantations, 26744Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel
| | - Nir Horesh
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of General Surgery and Transplantations, 26744Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel
| |
Collapse
|
3
|
Hussein Al-Obaidi J. Early appendectomy in appendicular mass. BIONATURA 2022. [DOI: 10.21931/rb/2022.07.04.67] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Appendicular mass is a well-known complication of acute appendicitis. It is conventionally treated conservatively, followed by interval appendectomy. This study aimed to determine the feasibility and safety of an early appendectomy in appendicular mass. Patients and methods: The analysis was performed at the Department of Surgery Al-Shafaa Hospital Diyala from March 2017 to December 2021. The patients with appendicular mass (n = 100) were included in this study. Patients were divided into two groups, viz. group A (n = 50) and group B (n = 50), regardless of age and gender. After preliminary investigations, appendectomy was performed in group A patients immediately. Group B patients were initially treated with the conventional procedure followed by interval appendectomy. Patient compliance, readmission and overall expenses were recorded for both groups. Results: A total of 60 (64%) males and 40 (40%) females with a mean age of 25.09 years (Range 8-44 years) are included in the study population. Post-operative wound sepsis occurred in 3 (6%) patients in group A. Treatment failure, patient compliance, readmission and overall expenses occurred in group B patients. Early appendectomy was a safe and superior option in patients with appendicular mass compared to conventional treatment.
Keywords: Acute appendicitis. Appendicular Mass, Conservative management, immediate surgery.
Collapse
Affiliation(s)
- Jaleel Hussein Al-Obaidi
- Al-kindy College of Medicine, Baghdad University, Iraq; 2 Medical director of Al-Shafa private hospital, Iraq
| |
Collapse
|
4
|
Davari FV, Hashem Zadeh A. A rare case of appendiceal tip complete attachment to a sigmoid diverticulum: An appendiceal phlegmon case report. Int J Surg Case Rep 2022; 97:107379. [PMID: 35841756 PMCID: PMC9403015 DOI: 10.1016/j.ijscr.2022.107379] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2022] [Revised: 06/27/2022] [Accepted: 06/27/2022] [Indexed: 02/07/2023] Open
Abstract
INTRODUCTION Appendiceal phlegmon is defined as an inflammatory mass, consisting of the inflamed appendix, enclosed by adjacent viscera and the greater omentum in 2 % to 10 % of patients with acute appendicitis. CASE PRESENTATION A 24-year-old female presented to the hospital with chief complaints of fever, nausea, vomiting, and pain over the right lower quadrant of the abdomen for two days. In the local examination, tenderness and rebound tenderness were detected. Ultrasonography and abdominal CT scan indicated appendiceal phlegmon. After seven weeks of receiving a course of antibiotics with complete resolution of her symptoms, she underwent elective laparoscopic appendectomy. During surgery, the appendiceal tip was completely attached and fused to a sigmoid diverticulum, which has not been reported elsewhere. The appendix was completely removed, and the patient was discharged from the hospital in a good general condition after two days. DISCUSSION Acute appendicitis can cause serious complications, such as ruptured appendix, abscess, or phlegmon. In most cases, inflammation and infection resolve by antibiotic administration. In some cases perforation of the inflamed appendix and local abscess or diffuse peritonitis formation, which requires immediate percutaneous drainage or surgery as indicated. Theoretically, the inflamed appendix can cause adhesive damage to the adjacent organs; however, there is no particular report on this type of damage. CONCLUSION This rare case suggests that during phlegmon formation and related inflammation, other complications such as fistula formation, are theoretically expected.
Collapse
Affiliation(s)
- Farzad Vaghef Davari
- Surgery Fellowship of Surgical Oncology, Tehran University of Medical Sciences, Iran
| | - Arezou Hashem Zadeh
- Student's Scientific Research Center, Tehran University of Medical Sciences, Tehran, Iran,Corresponding author at: Imam Khomeini Complex Hospital, Tohid squre, Tehran Postal code: 1419733141, Iran.
| |
Collapse
|
5
|
Mejri A, Arfaoui K, Mseddi MA, Slima MB, Saad S, Yahyaoui M. The management of appendicular abscesses in a Tunisian Tertiary Care Hospital. BMC Surg 2021; 21:427. [PMID: 34922528 PMCID: PMC8684085 DOI: 10.1186/s12893-021-01424-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Accepted: 11/15/2021] [Indexed: 12/26/2022] Open
Abstract
Background This study aims to describe the epidemiological, clinical, and radiological features of appendicular abscesses, compare the different approaches, and assess the safety and utility of laparoscopy in its management. Methods This descriptive retrospective study was carried out over 3 years extending from January 2017 to December 2019, reporting 150 appendicular abscesses cases. Data were collected from the register of the general surgery department B of the Rabta hospital. Cases with appendicular abscess were included. Files concerning patients with early appendicitis, non-appendicular abscesses or generalized appendicular peritonitis were excluded. Data were analysed with Statistical Package for the Social Sciences (SPSS) software. In univariate analysis, we used the chi2 test, the Fischer test, the Student t test. The factors retained by the univariate analysis were introduced into a logistic regression model. The significance level was set to 0.05. Results The mean age was 40.51 years. The gender ratio in patients with appendicular abscesses was M:F 1.94:1. Pain in the right iliac fossa associated with fever was the most common symptom (78% of cases). Clinical examination showed tenderness in the right iliac fossa in 38% of cases, rebound and guarding were found in 77 patients (51.3%), and a palpable mass was noted in 4 cases (4.2%). Imaging was done to confirm diagnosis; 46 patients underwent ultrasonogram and this confirmed the diagnosis in 26 patients (56%), while among the 71 patients who underwent CT abdomen confirmatory diagnosis was made in 65 patients (91.55%). An appendectomy was performed in 148 patients (98.6%) via laparoscopic approach in 94 patients, open Mac burney procedure in 32 cases (21.3%) and midline incision in 24 cases (16%). Two patients had an ileocecal resection. The appendix was most commonly located retrocecally (55.3%) in our cohort. The laparoscopic approach was performed in 94 patients (62.6%), and we had to convert in 44 patients due to dissection difficulties (46.8%). Among patients who underwent laparascopic approach 7 had developed peritonitis.. There were only 2 deaths. The mortality rate was 0,013%. The median duration of outpatient followup was 6 months (4–24 weeks) and was uneventful. Conclusion Appendicular abscess is a disease of young adults more common in men. Location of the appendix in our case series was mostly retroceacal. Laparoscopy was associated with good outcomes; peritonitis was uncommon and mortality was rare. The laparoscopic approach is a safe surgical technique for treating appendicular abscess and it can be considered as the routine approach for this condition In developing countries with limited technical resources, laparoscopy guarantees the absence of recurrence, reduces healthcare costs and decreases the risk of treating a severe disease conservatively.
Collapse
Affiliation(s)
- Atef Mejri
- Department of General Surgery, Jendouba Hospital, Jendouba, Tunisia. .,Faculty of Medicine of Tunis, Tunis El Manar University, Tunis, Tunisia.
| | - Khaoula Arfaoui
- Department of General Surgery, Jendouba Hospital, Jendouba, Tunisia.,Faculty of Medicine of Tunis, Tunis El Manar University, Tunis, Tunisia
| | - Mohamed Ali Mseddi
- Department of General Surgery, Jendouba Hospital, Jendouba, Tunisia.,Faculty of Medicine of Tunis, Tunis El Manar University, Tunis, Tunisia
| | - Mohamed Ben Slima
- Faculty of Medicine of Tunis, Tunis El Manar University, Tunis, Tunisia.,Department B of General Surgery, Rabta Hospital, Tunis, Tunisia
| | - Sarra Saad
- Faculty of Medicine of Tunis, Tunis El Manar University, Tunis, Tunisia.,Department B of General Surgery, Rabta Hospital, Tunis, Tunisia
| | - Marwen Yahyaoui
- Faculty of Medicine of Tunis, Tunis El Manar University, Tunis, Tunisia.,Department B of General Surgery, Rabta Hospital, Tunis, Tunisia
| |
Collapse
|
6
|
Sekine Y, Sugo H, Miyano S, Watanobe I, Machida M, Kojima K. Surgical Outcomes of Interval Laparoscopic Appendectomy for Appendiceal Abscess and Predictors of Conversion to Open Surgery. Indian J Surg 2021. [DOI: 10.1007/s12262-021-02819-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
|
7
|
Ahmed A, Feroz SH, Dominic JL, Muralidharan A, Thirunavukarasu P. Is Emergency Appendicectomy Better Than Elective Appendicectomy for the Treatment of Appendiceal Phlegmon?: A Review. Cureus 2020; 12:e12045. [PMID: 33447475 PMCID: PMC7802400 DOI: 10.7759/cureus.12045] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Appendiceal phlegmon is considered to be sequelae to acute appendicitis which presents as an appendiceal mass composed of the inflamed appendix, the adjacent bowel loops, and the greater omentum. The definitive diagnosis can be obtained by a CT scan of the abdomen. Though conservative management was the most practiced approach, recent studies have shifted the trends towards immediate appendicectomy for the management of appendiceal phlegmon. Thus, the management of appendiceal phlegmon has been debatable. Evidence to support this review was gathered via the PubMed database as this database uses the Medline, PubMed Central, and NLM databases and also offers a quick diverse search with up-to-date citations and numerous open-access free articles focused on Medicine. We did not include other databases like Google Scholar, Embase, and Scopus due to its limited access to free articles, recent articles, and citation information. Search terms used were combinations of "Appendicitis," "Appendiceal phlegmon", "Appendiceal phlegmon (AND) appendicectomy ". The resultant studies were reviewed and cross‐referenced for additional reports. Emergency appendicectomy is defined as appendicectomy carried out during the same, initial admission. An elective or interval appendicectomy is an appendicectomy carried out four to six weeks after the initial episode at a later admission. The interval is bridged by antibiotics and conservative management. Emergency appendicectomy is considered to have a higher rate of complications when compared to conservative management for appendiceal phlegmon. However, interval appendicectomy requires multiple re-admissions, leads to delayed diagnosis of any underlying pathology, and an increased risk of recurrent appendicitis. In our review, we aimed to compare and contrast the effectiveness of the different treatment modalities available for appendiceal phlegmon. Though the meta-analyses showed an increased association of complications with emergency appendicectomy, they included studies conducted before the laparoscopic era. Emergency appendicectomy decreases the financial burden, re-admission rate, and aids in the early diagnosis of any underlying pathology. In the laparoscopic era, we can consider the shifting trends towards emergency appendicectomy for the management of appendiceal phlegmon.
Collapse
Affiliation(s)
- Asma Ahmed
- General Surgery, Ramaiah Medical College and Hospital, Bangalore, IND
| | - Shah Huzaifa Feroz
- General Surgery, Jawaharlal Nehru Medical College, Aligarh, IND.,General Surgery, Larkin Community Hospital, Miami, USA
| | | | | | | |
Collapse
|
8
|
Management of appendiceal mass and abscess in children; early appendectomy or initial non-operative treatment? A systematic review and meta-analysis. Surg Endosc 2020; 34:5234-5249. [PMID: 32710216 PMCID: PMC7644542 DOI: 10.1007/s00464-020-07822-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Accepted: 07/10/2020] [Indexed: 12/26/2022]
Abstract
Background Appendiceal mass and abscess and its treatment are associated with significant morbidity and high costs. Still, the optimal treatment strategy is the point of debate. Therefore, this systematic review and meta-analysis aimed to compare overall complications between initial non-operative treatment (NOT) and early appendectomy (EA) in children with appendiceal mass and/or abscess. Methods Pubmed and Embase were searched. Only randomized controlled trials and prospective or historical cohort studies that compared NOT with EA in children with appendiceal mass or abscess in terms of complications were eligible for inclusion. Risk of bias was assessed. Primary outcome was the overall complication rate. Secondary, length of stay and readmission rate were investigated. A meta-analysis of overall complications associated with both treatment strategies was performed. Results 14 of 7083 screened studies were selected, including 1022 children in the NOT group and 333 in the EA group. Duration of follow-up ranged between four weeks and 12 years. Risk of bias was moderate in four and serious in 10 studies. NOT was associated with a lower overall complication rate (risk ratio (RR) 0.37 [95% confidence interval (CI) 0.21–0.65]). However, NOT led to increased length of stay (mean difference varied between 0.2 and 8.4 days) and higher readmission rate (RR 1.75 [95%CI 0.79–3.89]), although not significantly. Interval appendectomy after NOT was performed as a routine procedure in all but one study. This study found a recurrence rate of 34% in a group of 38 patients during a follow-up period of 3.4 ± 1.7 years. Conclusion NOT may reduce the overall complication rate compared to EA, but the evidence is very uncertain. As evidence is scarce, and of low level, and heterogeneity between studies is substantial, the results should be interpreted with caution. Large prospective studies are needed to determine the optimal treatment strategy for children with appendiceal mass and/or abscess. Electronic supplementary material The online version of this article (10.1007/s00464-020-07822-y) contains supplementary material, which is available to authorized users.
Collapse
|
9
|
Abstract
AIM To compare the outcomes in children who underwent emergency surgery and those who underwent percutaneous drainage for appendicular abscess. MATERIALS AND METHODS In this prospective study, 45 children of appendicular abscess detected on ultrasonogram (USG) were included in the study. The following characteristics were registered: age, gender, the time from onset of symptoms to seeking care, pain, vomiting, fever and general peritonitis; white blood cell count. The size, location of the abscess was noted on USG. After the diagnosis, we divided the patients into two groups based on the type of management. Patients who underwent emergency surgery and appendectomy (Group 1) which composed of twenty patients (14 males and six females) with their ages ranged from 3 to 18 years, and patients treated with ultrasound-guided percutaneous drainage and interval appendectomy (Group 2) which composed of 25 patients, (15 males and ten females) with their ages ranged from 2 to 18 years. RESULTS Group 1 included twenty patients and Group 2 included 25 patients. In Group 1, on USG the average size of the abscess was 7.2 ± 2.5 cm. After the surgery regained their functional recovery during a mean period of 3.2 ± 1 days. In Group 2, on USG average abscess size was 6.8 ± 2.4 cm. After the procedure regained their functional recovery on the second day. No major complications were noted in Group 2. On the contrary, 12 patients (60%) of Group 1 show complications in the form of wound infection in eight children and wound dehiscence in four children. CONCLUSIONS USG-guided percutaneous drainage was safe and effective way of management of appendicular abscess.
Collapse
Affiliation(s)
- Nandkishor Shinde
- Department of Surgery, Pediatric Surgery Unit, Khaja Banda Nawaz Institute of Medical Sciences, Gulbarga, Karnataka, India
| | - Ravindra Devani
- Department of Surgery, Pediatric Surgery Unit, Khaja Banda Nawaz Institute of Medical Sciences, Gulbarga, Karnataka, India
| | - Mohammed Abdul Baseer
- Department of Surgery, Pediatric Surgery Unit, Khaja Banda Nawaz Institute of Medical Sciences, Gulbarga, Karnataka, India
| | - Kiran Desai
- Department of Radiology, Khaja Banda Nawaz Institute of Medical Sciences, Gulbarga, Karnataka, India
| |
Collapse
|
10
|
Zavras N, Vaos G. Management of complicated acute appendicitis in children: Still an existing controversy. World J Gastrointest Surg 2020; 12:129-137. [PMID: 32426092 PMCID: PMC7215970 DOI: 10.4240/wjgs.v12.i4.129] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2019] [Revised: 03/24/2020] [Accepted: 03/30/2020] [Indexed: 02/06/2023] Open
Abstract
Complicated acute appendicitis (CAA) is a serious condition and carries significant morbidity in children. A strict diagnosis is challenging, as there are many lesions that mimic CAA. The management of CAA is still controversial. There are two options for treatment: Immediate operative management and non-operative management with antibiotics and/or drainage of any abscess or phlegmon. Each method of treatment has advantages and disadvantages. Operative management may be difficult due to the presence of inflamed tissues and may lead to detrimental events. In many cases, non-operative management with or without drainage and interval appendectomy is advised. The reasons for this approach include new medications and policies for the use of antibiotic therapy. Furthermore, advances in radiological interventions may overcome difficulties such as diagnosing and managing the complications of CAA without any surgeries. However, questions have been raised about the risk of recurrence, prolonged use of antibiotics, lengthened hospital stay and delay in returning to daily activities. Moreover, the need for interval appendectomy is currently under debate because of the low risk of recurrence. Due to the paucity of high-quality studies, more randomized controlled trials to determine the precise management strategy are needed. This review aims to study the current data on operative vs non-operative management for CAA in children and to extract any useful information from the literature.
Collapse
Affiliation(s)
- Nick Zavras
- Department of Paediatric Surgery, “ATTIKON” University General Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens 12462, Greece
| | - George Vaos
- Department of Paediatric Surgery, “ATTIKON” University General Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens 12462, Greece
| |
Collapse
|
11
|
Hester CA, Pickett M, Abdelfattah KR, Cripps MW, Dultz LA, Dumas RP, Grant JL, Luk S, Minei J, Park C, Shoultz TH. Comparison of Appendectomy for Perforated Appendicitis With and Without Abscess: A National Surgical Quality Improvement Program Analysis. J Surg Res 2020; 251:159-167. [PMID: 32151825 DOI: 10.1016/j.jss.2019.12.054] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2019] [Revised: 12/15/2019] [Accepted: 12/29/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND Outcomes of appendectomy stratified by type of complicated appendicitis (CA) features are poorly researched, and the evidence to guide operative versus nonoperative management for CA is lacking. This study aimed to determine laparoscopic-to-open conversion risk, postoperative abscess risk, unplanned readmission risk, and length of hospital stay (LOS) associated with appendectomy in patients with perforated appendicitis without abscess (PA) and perforated appendicitis with abscess (PAWA) compared with a control cohort of nonperforated appendicitis (NPA). METHODS The 2016-2017 National Surgical Quality Improvement Program Appendectomy-targeted database identified 12,537 (76.1%) patients with NPA, 2142 (13.0%) patients with PA, and 1799 (10.9%) patients with PAWA. Chi-squared analysis and analysis of variance were used to compare categorical and continuous variables. Binary logistic and linear regression models were used to compare risk-adjusted outcomes. RESULTS Compared with NPA, PA and PAWA had higher rates of conversion (0.8% versus 4.9% and 6.5%, respectively; P < 0.001), postoperative abscess requiring intervention (0.6% versus 4.8% and 7.0%, respectively; P < 0.001), readmission (2.8% versus 7.7% and 7.6%, respectively; P < 0.001), and longer median LOS (1 day versus 2 days and 2 days, respectively; P < 0.001). PA and PAWA were associated with increased odds of postoperative abscess (odds ratio [OR]: 7.18, 95% confidence interval [CI]: 5.2-9.8 and OR: 9.94, 95% CI: 7.3-13.5, respectively), readmission (OR: 2.70, 95% CI: 2.1-3.3 and OR: 2.66, 95% CI: 2.2-3.3, respectively), and conversion (OR: 5.51, 95% CI: 4.0-7.5 and OR: 7.43, 95% CI: 5.5-10.1, respectively). PA was associated with an increased LOS of 1.7 days and PAWA with 1.9 days of LOS (95% CI: 1.5-1.8 and 1.7-2.1, respectively). CONCLUSIONS Individual features of CA were independently associated with outcomes. Further research is needed to determine if surgical management is superior to nonoperative management for CA.
Collapse
Affiliation(s)
- Caitlin A Hester
- Department of Surgery, Division of General and Acute Care Surgery, Dallas, Texas
| | - Maryanne Pickett
- Department of Surgery, Division of General and Acute Care Surgery, Dallas, Texas
| | - Kareem R Abdelfattah
- Department of Surgery, Division of General and Acute Care Surgery, Dallas, Texas
| | - Michael W Cripps
- Department of Surgery, Division of General and Acute Care Surgery, Dallas, Texas
| | - Linda A Dultz
- Department of Surgery, Division of General and Acute Care Surgery, Dallas, Texas
| | - Ryan P Dumas
- Department of Surgery, Division of General and Acute Care Surgery, Dallas, Texas
| | - Jennifer L Grant
- Department of Surgery, Division of General and Acute Care Surgery, Dallas, Texas
| | - Stephen Luk
- Department of Surgery, Division of General and Acute Care Surgery, Dallas, Texas
| | - Joseph Minei
- Department of Surgery, Division of General and Acute Care Surgery, Dallas, Texas
| | - Caroline Park
- Department of Surgery, Division of General and Acute Care Surgery, Dallas, Texas
| | - Thomas H Shoultz
- Department of Surgery, Division of General and Acute Care Surgery, Dallas, Texas.
| |
Collapse
|
12
|
Early appendectomy vs. conservative management in complicated acute appendicitis in children: A meta-analysis. J Pediatr Surg 2019; 54:2234-2241. [PMID: 30857730 DOI: 10.1016/j.jpedsurg.2019.01.065] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Revised: 01/29/2019] [Accepted: 01/29/2019] [Indexed: 12/16/2022]
Abstract
BACKGROUND No consensus exists among surgeons regarding the optimal treatment of complicated acute appendicitis in children (CAA). Existing studies present heterogeneity of data and only few studies analyzed free perforated appendicitis (FPA) separately from appendicular abscess (AAb) and appendicular phlegmon (AP). METHOD Studies which have been judged eligible for this systematic review and consequent meta-analysis are those comparing non-operative management (NOM) with operative management (OM) in children with CAA. Studies were subgrouped between those analyzing mixed patients with CAA, those focusing on patients with AAb/AP and those focusing on patients with FPA. RESULTS Fourteen studies fulfilled the inclusion criteria and were included in the meta-analysis with a total of 1288 patients. In the fixed-effects model the complication rate was significantly favorable to the initial NOM arm for the AAb/AP subgroup (RR = 0.07, 95%CI = 0.02-0.27) and to the OM arm for the FPA subgroup (RR = 1.86, 95%CI = 1.20-2.87); the re-admission rate was significantly favorable to the initial NOM arm for the AAb/AP subgroup (RR = 0.35, 95%CI = 0.13-0.93) and to the OM arm for the FPA subgroup (RR = 1.49, 95%CI = 1.49-7.44). There was no statistical heterogeneity for the two subgroups of patients. The costs weren't significantly different between NOM and OM. The length of stay was favorable to OM. The pooled proportion rate of NOM success was 90%, the pooled relapse rate of appendicitis was 15.4%. CONCLUSIONS Children with AAb/AP reported better results in terms of complication rate and re-admission rate if treated with NOM. Conversely children with FPA showed lower complication rate and re-admission rate if treated with OM. LEVEL OF EVIDENCE II.
Collapse
|
13
|
Vaos G, Dimopoulou A, Gkioka E, Zavras N. Immediate surgery or conservative treatment for complicated acute appendicitis in children? A meta-analysis. J Pediatr Surg 2019; 54:1365-1371. [PMID: 30115448 DOI: 10.1016/j.jpedsurg.2018.07.017] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Revised: 07/19/2018] [Accepted: 07/20/2018] [Indexed: 12/15/2022]
Abstract
PURPOSE This study carried out a meta-analysis to compare immediate surgery (IS) with conservative treatment (CT) of complicated acute appendicitis (CAA) in children. METHODS Systematic literature research was performed for relevant studies published from 1969 to date. Trials of IS compared with CT were included. Outcomes of interest were postoperative morbidity and length of hospital stay (LOS). RESULTS Fifteen trials were studied (1.243 patients). CT achieved better rates of any complication type (odds ratio [OR] 0.22, [95% confidence interval (CI): 0.14, 0.38], p = 0.001) and wound infection (OR: 0.40 [95% CI: 0.17, 0.96], p = 0.041). Neither intraabdominal abscess (OR: 1.03 [95% CI: 0.31, 3.37], p = 0.958) nor postoperative ileus (OR: 0.29 [95% CI: 0.06, 1.44], p = 0.130) was affected by the treatment option. The polled difference in LOS showed a trend for shorter LOS in the IS group (standard mean difference [SMD]: 0.25 [95% CI: 0.07, -0.43], p = 0.007). CONCLUSIONS IS was associated with shorter LOS, while overall complication rates and wound infection declined significantly with CT. The development of intraabdominal abscess and postoperative ileus was not affected by the treatment of choice. The heterogeneity of most studies depicts the need for randomized controlled trials (RCTs) to discover safe management of CAA in children. LEVEL OF EVIDENCE III: Type of study: Meta-analysis.
Collapse
Affiliation(s)
- George Vaos
- Department of Paediatric Surgery, Attikon University General Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece.
| | - Anastasia Dimopoulou
- Department of Paediatric Surgery, Attikon University General Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Eleana Gkioka
- Second Department of Paediatrics, Athens Medical Center, Athens, Greece
| | - Nick Zavras
- Department of Paediatric Surgery, Attikon University General Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| |
Collapse
|
14
|
Coccolini F, Fugazzola P, Sartelli M, Cicuttin E, Sibilla MG, Leandro G, De' Angelis GL, Gaiani F, Di Mario F, Tomasoni M, Catena F, Ansaloni L. Conservative treatment of acute appendicitis. ACTA BIO-MEDICA : ATENEI PARMENSIS 2018; 89:119-134. [PMID: 30561405 PMCID: PMC6502196 DOI: 10.23750/abm.v89i9-s.7905] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Indexed: 12/17/2022]
Abstract
Acute appendicitis has been considered by surgeons a progressive disease leading to perforation for more than 100 years. In the last decades the theories about this concept gained attention, especially in adults. However, appendectomy for acute appendicitis remains the most common urgent/emergent surgical procedure. At present, accumulating evidences are showing the changing in clinical practice towards the non-operative management of several cases of acute appendicitis either non-complicated or complicated. The present review aims to show the literature results regarding the non-operative management of acute appendicitis in non-complicated and in complicated cases.
Collapse
Affiliation(s)
- Federico Coccolini
- Emergency, General and Trauma Surgery dept., Bufalini hospital, Cesena, Italy.
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
15
|
Gavriilidis P, de'Angelis N, Katsanos K, Di Saverio S. Acute Appendicectomy or Conservative Treatment for Complicated Appendicitis (Phlegmon or Abscess)? A Systematic Review by Updated Traditional and Cumulative Meta-Analysis. J Clin Med Res 2018; 11:56-64. [PMID: 30627279 PMCID: PMC6306138 DOI: 10.14740/jocmr3672] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Accepted: 11/10/2018] [Indexed: 12/13/2022] Open
Abstract
Background The existing evidence on the treatment of complicated appendicitis favors conservative treatment rather than acute appendicectomy. Update traditional meta-analysis and consequently cumulative meta-analysis was performed to track the accumulation of evidence over time. Methods Studies were identified by a systematic literature search of the EMBASE, PubMed, Cochrane Library and Google Scholar databases. The main outcome measures were duration of the first hospitalization, overall duration of hospitalization, duration of intravenous (IV) antibiotic treatment, overall complications, abdominal/pelvic abscesses, wound infections, re-admissions and unplanned re-operations. Results Overall complications, abdominal/pelvic abscesses, wound infections and unplanned procedures were significantly lower in the conservative treatment cohort. In contrast, subgroup analysis of three randomized controlled trials (RCTs) revealed no significant difference in abdominal/pelvic abscesses (odds ratio (OR): 0.46, 95% confidence interval (CI): 0.17 - 1.29, P = 0.14). No significant differences were found in the duration of the first and overall hospitalizations. Of the note, high-quality RCTs demonstrated a shorter hospital stay by 1 day for the laparoscopic appendicectomy cohort compared to conservative treatment (mean difference (MD): -0.99, 95% CI: -1.31 to -0.67, P < 0.0001). Conclusion The present meta-analysis demonstrates that a shift in paradigm has begun, with a more widespread use of the laparoscopic approach for the management of complicated appendicitis.
Collapse
Affiliation(s)
- Paschalis Gavriilidis
- Department of General and Colorectal Surgery, William Harvey Hospital, East Kent Hospitals University, NHS Trust, Ashford, UK
| | - Nicola de'Angelis
- Department of Digestive Surgery, Henri Mondor University Hospital, 94010 Creteil, France
| | - Konstantinos Katsanos
- Department of Interventional Radiology, Patras University Hospital, School of Medicine, Rion, 26504 Patras, Greece
| | - Salomone Di Saverio
- Department of Colorectal Surgery, Cambridge University Hospitals NHS Foundation Trust, Addenbrooke's Hospital, Hills Road, Cambridge CB2 0QQ, UK
| |
Collapse
|
16
|
|
17
|
Sadakari Y, Date S, Murakami S, Ichimiya S, Nishimura S, Kawaji H, Sagara A, Castillo JR, Ishikawa M, Kamimura T, Uchiyama A, Nakamura M. Prediction of Negative Outcomes in Non-Surgical Treatment for Appendiceal Abscess in Adults. JOURNAL OF THE ANUS RECTUM AND COLON 2018; 2:59-65. [PMID: 31583322 PMCID: PMC6768819 DOI: 10.23922/jarc.2017-051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Accepted: 01/30/2018] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Non-surgical treatment is an acceptable approach for managing appendiceal abscess in adults. However, it is only applicable for selected patients, and conversion to surgery is mandatory for failed conservative treatment. This study aimed to determine the predictive factors for unsuccessful outcomes. METHODS Of 594 patients with acute appendicitis, 34 (5.7%) diagnosed with appendiceal abscess were initially treated conservatively. Patients were divided into two groups: the conservative group, which was successfully treated with antibiotics and percutaneous abscess drainage, and the conversion group, which comprised patients who had surgical conversion despite conservative treatment. Risk factors for the conversion group were investigated by comparing clinical and radiological parameters between the two groups. RESULTS Eight (23.4%) patients were converted to surgical management at an average of 5.5 days of non-surgical treatment. An abscess size greater than 40 mm and a lower rate of improvement in the white blood cell (WBC) count were significant factors for predicting conversion in multivariate analysis. The conversion group had a long operative time and high morbidity and operative conversion rates (change of proposed initial operation). Early conversion to operation group, i.e., less than 5 days of treatment, contributed to a significantly shorter hospital stay, lower hospital cost, and relatively shorter operative time (p = 0.02, p = 0.04, and p = 0.11, respectively). CONCLUSIONS Contributing factors in predicting unsuccessful outcomes for non-surgical treatment include an abscess size greater than 40 mm and a low rate of improvement in WBC count on the first day of antibiotic treatment.
Collapse
Affiliation(s)
- Yoshihiko Sadakari
- Department of Surgery, JCHO Kyushu Hospital, Fukuoka, Japan.,Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Satomi Date
- Department of Surgery, JCHO Kyushu Hospital, Fukuoka, Japan.,Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | | | - Shu Ichimiya
- Department of Surgery, JCHO Kyushu Hospital, Fukuoka, Japan.,Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | | | - Hitomi Kawaji
- Department of Surgery, JCHO Kyushu Hospital, Fukuoka, Japan.,Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Akiko Sagara
- Department of Surgery, JCHO Kyushu Hospital, Fukuoka, Japan.,Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Jaymel R Castillo
- Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Mikimasa Ishikawa
- Department of Surgery, JCHO Kyushu Hospital, Fukuoka, Japan.,Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | | | - Akihiko Uchiyama
- Department of Surgery, JCHO Kyushu Hospital, Fukuoka, Japan.,Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Masafumi Nakamura
- Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| |
Collapse
|
18
|
Symer MM, Abelson JS, Sedrakyan A, Yeo HL. Early operative management of complicated appendicitis is associated with improved surgical outcomes in adults. Am J Surg 2018; 216:431-437. [PMID: 29703594 DOI: 10.1016/j.amjsurg.2018.04.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Revised: 04/11/2018] [Accepted: 04/16/2018] [Indexed: 12/14/2022]
Abstract
BACKGROUND There is no consensus on the ideal management of complicated appendicitis. METHODS The New York State Planning and Research Cooperative database was used to identify all patients admitted with complicated appendicitis and undergoing appendectomy within 1-year. Primary outcome was any complication. Secondary outcomes included length of stay (LOS), hospital charges, and laparoscopy use. Outcomes were compared in appendectomy before or after 48h from admission. RESULTS 31,167 patients ≥18yo were identified for analysis, 28,015(89.9%) underwent early appendectomy. Early appendectomy patients were more likely to be White (69.8% vs. 64.2% p < 0.01), and commercially insured (53.1% vs. 45.4%, p < 0.01). Of the 3152 undergoing delayed surgery, 1610(51.1%) had surgery later during the index admission, 715(22.7%) were readmitted urgently and underwent appendectomy, and 827(26.2%) had elective appendectomy. Patients undergoing delayed surgery had more complications (OR 1.34 95%CI 1.23-1.45), readmissions (OR 1.55 95%CI 1.42-1.70), high hospital charges (OR 4.79 95%CI 4.35-5.27), and prolonged LOS (OR 6.12 95%CI 5.61-6.68). CONCLUSIONS In this population-level study of complicated appendicitis we found more complications, longer LOS, and higher charges in patients undergoing delayed surgery.
Collapse
Affiliation(s)
- Matthew M Symer
- NewYork-Presbyterian Hospital / Weill Cornell Medicine, Department of Surgery, New York, NY, USA
| | - Jonathan S Abelson
- NewYork-Presbyterian Hospital / Weill Cornell Medicine, Department of Surgery, New York, NY, USA
| | - Art Sedrakyan
- Weill Cornell Medicine, Department of Healthcare Policy and Research, New York, NY, USA
| | - Heather L Yeo
- NewYork-Presbyterian Hospital / Weill Cornell Medicine, Department of Surgery, New York, NY, USA; Weill Cornell Medicine, Department of Healthcare Policy and Research, New York, NY, USA.
| |
Collapse
|
19
|
Baba TF, Mbar WTM, Lamine DM, Aly SM, Noel TJ, Mamadou C, Tidiane TC, Ibrahima K. [Appendicular plastron: emergency or deferred surgery: a series of 27 cases collected in the surgical clinic of the Aristide Le Dantec Hospital]. Pan Afr Med J 2018; 29:15. [PMID: 29662600 PMCID: PMC5899775 DOI: 10.11604/pamj.2018.29.15.10038] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2016] [Accepted: 08/07/2017] [Indexed: 11/13/2022] Open
Abstract
Le but de notre étude était d’évaluer les résultats du traitement chirurgicale du plastron appendiculaire après appendicectomie différée ou immédiate. Il s’agit d’une étude rétrospective de type descriptif allant de Janvier 2000 au 31 Décembre 2007 portant sur 27 patients reçus et traités pour plastron appendiculaire. Le diagnostic était clinique par la présence d’une masse à la fosse iliaque droite, échographique, ou per opératoire. Tous les patients opérés en urgence ont été classés dans le groupe I et ceux opérés à froid, groupe II. Nous avons noté 18 hommes et 9 femmes avec un sex-ratio homme /femme = 3. L’âge moyen de nos patients était de 33 ans avec des extrêmes de 19 et 57 ans. Les signes cliniques étaient dominés par la douleur à la fosse iliaque droite et la fièvre respectivement 25 (92,6%) et 15 (55,6%) des cas. Dans le groupe I, l’appendicectomie n’a pu être réalisée pour 7 patients (n = 15) dû aux difficultés opératoires. Dans les autres cas, l’appendicectomie était possible au prix de l’élargissement de l’incision de Mac Burney et une durée de séjour plus longue. Le groupe II a concerné 12 patients (n = 12) avec 9 abords laparoscopiques et dans 3 cas, la voie de Mac Burney a été empruntée. Trois cas d’adhérences péritonéales ont été notés lors de la coelioscopie. L’appendicectomie à froid du plastron appendiculaire est un procédé sûr et efficace. Elle permet d’éviter les cicatrices inesthétiques et les fistules digestives iatrogènes. L’appendicectomie immédiate doit être abandonnée chez les patients porteurs de plastron appendiculaire car elle engendre beaucoup de morbidité.
Collapse
Affiliation(s)
| | | | - Diao Mohamed Lamine
- Département de Chirurgie et Spécialité Université Gaston de Saint-Louis, Sénégal
| | | | - Tendeng Jacques Noel
- Département de Chirurgie et Spécialité Université Gaston de Saint-Louis, Sénégal
| | | | | | - Konaté Ibrahima
- Hôpital Aristide Le Dantec, Dakar, Sénégal.,Département de Chirurgie et Spécialité Université Gaston de Saint-Louis, Sénégal
| |
Collapse
|
20
|
Minimally Invasive Treatment for Appendiceal Mass Formed After Acute Perforated Appendicitis. Surg Laparosc Endosc Percutan Tech 2018; 27:132-138. [PMID: 28414702 DOI: 10.1097/sle.0000000000000404] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
The optimal treatment for appendiceal mass formed after appendiceal rupture due to acute appendicitis is surrounded with controversy. The treatment strategy ranges from open surgery (emergency or interval appendectomy), laparoscopic appendectomy, and image-guided drainage, to conservative treatment with or without antibiotics. Nonsurgical treatment (including conservative and drainage treatment), followed by interval appendectomy to prevent recurrence, is the traditional management of these patients. The need for interval appendectomy after a successful conservative or/and image-guided drainage treatment, has recently been questioned as the risk of recurrence is relatively small. Several authors consider that even in cases involving only ambulatory follow-up observation, without interval surgery after conservative management, the recurrence rate and risks of missing underlying pathologies were not high. This article evaluates the minimally invasive treatment modalities in the management of appendiceal mass, risk of undetected serious disease, and the need for interval appendectomy to prevent recurrence.
Collapse
|
21
|
Tumen A, Chotai PN, Williams JM, Myers-Webb A, Krishnan R, Eubanks Iii JW. Neonatal Perforated Appendicitis Attributed to Localized Necrotizing Enterocolitis of the Appendix: A Review. J Neonatal Surg 2017; 6:60. [PMID: 28920020 PMCID: PMC5593479 DOI: 10.21699/jns.v6i3.535] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2017] [Accepted: 03/11/2017] [Indexed: 11/13/2022] Open
Abstract
Neonatal appendicitis is a rare clinical entity associated with remarkable morbidity and mortality. Appendicular perforation is common and the diagnosis is usually made intra-operatively. The causative etiology of neonatal perforated appendicitis (NPA) is a subject of debate and has not been elucidated. Although many etiologic theories exist, increasing evidence suggests a subset of NPA cases may represent a form of necrotizing enterocolitis (NEC) localized to the appendix. We herein present a review of the current literature to include cases of NPA attributed to localized NEC. A high index of clinical suspicion and early laparotomy are recommended.
Collapse
Affiliation(s)
- Andrew Tumen
- Division of Pediatric Surgery, Department of Surgery, University of Tennessee Health Science Center, Le Bonheur Children's Hospital, Memphis, TN, USA
| | - Pranit N Chotai
- Division of Pediatric Surgery, Department of Surgery, University of Tennessee Health Science Center, Le Bonheur Children's Hospital, Memphis, TN, USA.,Department of Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - John Matthew Williams
- Division of Neonatology, Department of Pediatrics, Regional One Health, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Adrianne Myers-Webb
- Division of Pediatric Surgery, Department of Surgery, University of Tennessee Health Science Center, Le Bonheur Children's Hospital, Memphis, TN, USA
| | - Ramesh Krishnan
- Division of Neonatology, Department of Pediatrics, Regional One Health, University of Tennessee Health Science Center, Memphis, TN, USA
| | - James W Eubanks Iii
- Division of Pediatric Surgery, Department of Surgery, University of Tennessee Health Science Center, Le Bonheur Children's Hospital, Memphis, TN, USA
| |
Collapse
|
22
|
C-reactive Protein may Predict the Recurrence of Appendicitis in Children Formerly with Appendiceal Mass after Successful Non-operative Treatment. Pediatr Neonatol 2017; 58:350-354. [PMID: 28089500 DOI: 10.1016/j.pedneo.2016.12.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2016] [Revised: 10/18/2016] [Accepted: 12/04/2016] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND This study identified factors associated with the recurrence of appendicitis in children with appendiceal masses after successful nonsurgical treatment. METHODS In this retrospective study, children who were diagnosed as having appendiceal masses after undergoing conservative treatment between 2000 and 2014 were enrolled and the medical records of those who did not undergo an interval appendectomy were reviewed. The clinical features and outcomes of patients with and those without recurrent appendicitis were compared. Regression analysis was used to identify risk factors of appendicitis recurrence. RESULTS Seventy patients were included and successfully discharged after receiving nonsurgical treatment for appendiceal masses. Of the patients, 35 (50.0%) developed recurrent appendicitis and 85.7% (30/35) recurrences developed within 3 months. Multivariate analyses showed that patients with a higher serum C-reactive protein (CRP) level and peritonitis more frequently developed recurrence. The appendicitis recurrence rate was significantly higher in the patients with CRP levels of ≥103 mg/L with an odds ratio of 16.9 or in those with peritonitis with an odds ratio of 4.9. CONCLUSION Children with appendiceal masses who develop peritonitis or have CRP levels of ≥103 mg/L have a higher recurrence rate of appendicitis and should undergo an interval appendectomy.
Collapse
|
23
|
Kim MS, Kim HJ, Park HW, Kwon HJ, Lee SY, Kook SH, Park HJ, Choi YJ. Impact of high-grade obstruction on outcomes in patients with appendiceal inflammatory masses managed by nonoperative treatment. Ann Surg Treat Res 2017; 92:429-435. [PMID: 28580348 PMCID: PMC5453876 DOI: 10.4174/astr.2017.92.6.429] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2016] [Revised: 11/28/2016] [Accepted: 01/17/2017] [Indexed: 12/26/2022] Open
Abstract
Purpose To retrospectively assess the impact of high-grade obstructions identified on initial CT on outcomes of patients with appendiceal inflammatory masses managed by nonoperative treatment. Methods Institutional Review Boards approved this retrospective study and informed consent was waived. Included were 52 consecutive patients diagnosed with appendiceal inflammatory masses by CT scan and managed by nonoperative treatment. The main outcome measure was treatment failure and secondary outcomes were complications and initial and total hospital stay. Patient demographics, inflammatory markers, and CT findings for presence of an appendiceal inflammatory mass and high-grade obstruction were assessed. Patients with and without high-grade obstruction were compared for patient characteristics and outcomes using Fisher exact test and Student t-test. Results Among 52 patients, 14 (27%) had high-grade obstruction on CT examination at presentation. No significant differences were observed in patient characteristics (P > 0.05), treatment failure (P = 0.33), complications (P = 0.29), or initial (P = 0.73) or total (P = 0.72) hospitalization between patients with and without high-grade obstruction. Conclusion For patients who were managed by nonoperative treatment for appendiceal inflammatory masses, the presence of high-grade obstruction identified on initial CT scan did not significantly affect outcomes of treatment failure, complications, and initial and total hospitalization.
Collapse
Affiliation(s)
- Mi Sung Kim
- Department of Radiology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hyuk Jung Kim
- Department of Radiology, Daejin Medical Center, Bundang Jesaeng General Hospital, Seongnam, Korea
| | - Hae Won Park
- Department of Radiology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Heon-Ju Kwon
- Department of Radiology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - So-Yeon Lee
- Department of Radiology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Shin Ho Kook
- Department of Radiology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hee-Jin Park
- Department of Radiology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Yoon Jung Choi
- Department of Radiology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| |
Collapse
|
24
|
Abstract
The aim of our study is to compare the results of emergency surgery versus conservative treatment with interval surgery in patients diagnosed with appendiceal mass and abscess. A retrospective review of 48 patients with appendiceal mass and abscess treated from January 2002 to January 2013 at General Surgery Department of Kipshidze Central University Hospital was performed. Patients with emergency surgery were compared to patients treated by nonoperative management with interval surgery. Demographics, clinical profile, and operative outcomes were studied. The emergency surgery group included 25 patients, and the interval surgery group included 23 patients. The clinical characteristics of the emergency surgery and interval surgery groups were not statistically different. In the emergency surgery group, an open appendectomy was performed on 17 patients, and colonic resections (ileocecectomy or right hemicolectomy) were performed on 8 patients. In the interval surgery group, an open appendectomy was performed on 21 patients, and colonic resections were performed on 2 patients. There were no statistical differences in types of surgery, postoperative complications, operation time without colonic resections, and postoperative hospitalization period among these 2 groups. Operation time with colonic resections was of greater duration in the emergency surgery group than in the interval surgery group (P = 0.04). Both treatment methods for appendiceal mass and abscess have the same results. The surgeon must consider clinical symptoms and results of investigations in each particular case when choosing an appropriate treatment method. Prospective randomized controlled trials are required for comparing the results of all 3 treatment methods of appendiceal mass.
Collapse
|
25
|
Festa N, Park KT, Schwenk H. Anchoring Bias as a Limiting Factor in High-Value Care: A Case of Fever of Unknown Origin in a Hospitalized Child. Hosp Pediatr 2016; 6:699-701. [PMID: 27789539 DOI: 10.1542/hpeds.2016-0027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Affiliation(s)
- Natalia Festa
- Stanford University School of Medicine, Stanford, California; and
| | - K T Park
- Stanford University School of Medicine, Stanford, California; and
- Lucile Packard Children's Hospital, Palo Alto, California
| | - Hayden Schwenk
- Stanford University School of Medicine, Stanford, California; and
- Lucile Packard Children's Hospital, Palo Alto, California
| |
Collapse
|
26
|
Darwazeh G, Cunningham SC, Kowdley GC. A Systematic Review of Perforated Appendicitis and Phlegmon: Interval Appendectomy or Wait-and-See? Am Surg 2016. [DOI: 10.1177/000313481608200107] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Patients with appendiceal abscess or phlegmon have been traditionally managed with antibiotics and radiologically guided drainage of the abscess. Many studies have questioned the need for interval appendectomy. A systematic review of the nonsurgical treatment of patients with an appendiceal abscess or phlegmon was undertaken. The rate of recurrence after nonsurgical management, morbidity and length of hospital stay was measured. PubMed and Cochrane databases were queried to identify 21 studies reporting the morbidity of nonsurgical treatment of appendiceal phlegmon or abscess, and five studies reporting the morbidity of performing interval appendectomy. Repeat nonsurgical management was compared with that of performing interval appendectomy. The studies included a total of 1943 patients, of which 1400 patients were managed nonsurgically and 543 patients underwent interval appendectomy. Nonoperative treatment had a mean recurrence of 12.4 per cent, a morbidity of 13.3 per cent, and the length of hospital stay was 9.6 days. The mean morbidity rate and length of hospital stay for patients who underwent interval appendectomy was 10.4 per cent and 5.0 days, respectively. Interval appendectomy and repeat nonoperative management in case of recurrence are associated with similar morbidity; however, elective interval appendectomy implies additional operative costs to prevent recurrence in one of eight patients.
Collapse
Affiliation(s)
- Ghaleb Darwazeh
- From the Department of Surgery, Saint Agnes Hospital, Baltimore, MD
| | | | - Gopal C. Kowdley
- From the Department of Surgery, Saint Agnes Hospital, Baltimore, MD
| |
Collapse
|
27
|
Seif HM, Reyad HA, Korany M, Metwally M, Ahmed AI. Immediate operation versus percutaneous drainage for treatment of appendicular abscess. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2015. [DOI: 10.1016/j.ejrnm.2015.06.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
|
28
|
Mentula P, Sammalkorpi H, Leppäniemi A. Laparoscopic Surgery or Conservative Treatment for Appendiceal Abscess in Adults? A Randomized Controlled Trial. Ann Surg 2015; 262:237-42. [PMID: 25775072 DOI: 10.1097/sla.0000000000001200] [Citation(s) in RCA: 72] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE We hypothesized that immediate laparoscopic surgery for appendiceal abscess would result in faster recovery than conservative treatment. BACKGROUND On the basis of the retrospective studies, conservative management of appendiceal abscess is recommended as a first line treatment, but some controversy exists. METHODS Sixty adult patients diagnosed with appendiceal abscess were randomly assigned to either laparoscopic surgery (n = 30) or conservative treatment (n = 30). Hospital stay, recurrences, additional interventions, and complications within 60 days from randomization were recorded. RESULTS There was no difference in hospital stay: 4 days (interquartile range: 3-5 days) in the laparoscopy group versus 5 days (3-8) in the conservative group, P = 0.105. Patients in the laparoscopy group had 10% risk for bowel resection and 13% risk for incomplete appendectomy. There were significantly fewer patients with unplanned readmissions in the laparoscopy group: 1 (3%) versus 8 (27%), P = 0.026. Additional interventions were required in 2 (7%) patients in the laparoscopy group (percutaneous drainage) and in 9 (30%) patients in the conservative group (surgery), P = 0.042. Recurrent abscesses and failure to respond to conservative treatment were the main reasons for additional interventions. Open surgery was required in 3 (10%) patients in the laparoscopy group and in 4 (13%) patients in the conservative group. Postoperative complications occurred in 3 patients in laparoscopic group versus 2 patients in the conservative group. The rate of uneventful recovery was 90% in the laparoscopy group versus 50% in the conservative group, P = 0.002. CONCLUSIONS Laparoscopic surgery in experienced hands is safe and feasible first-line treatment for appendiceal abscess. It is associated with fewer readmissions and fewer additional interventions than conservative treatment with comparable hospital stay.
Collapse
Affiliation(s)
- Panu Mentula
- Department of Abdominal Surgery, Helsinki University Central Hospital, Helsinki, Finland
| | | | | |
Collapse
|
29
|
Bachur RG, Callahan MJ, Monuteaux MC, Rangel SJ. Integration of ultrasound findings and a clinical score in the diagnostic evaluation of pediatric appendicitis. J Pediatr 2015; 166:1134-9. [PMID: 25708690 DOI: 10.1016/j.jpeds.2015.01.034] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2014] [Revised: 12/08/2014] [Accepted: 01/20/2015] [Indexed: 12/29/2022]
Abstract
OBJECTIVE To determine the predictive value of ultrasonography (US) for appendicitis in children when combined with clinical assessment based on the Pediatric Appendicitis Score (PAS). STUDY DESIGN Observational study of children aged 3-18 years who had an US examination for possible appendicitis. A PAS was calculated on the basis of historical elements, examination, and laboratory studies and was used to classify patients into 3 risk groups (low, medium, high). The predictive value of the PAS for appendicitis was calculated and stratified by the result of the US (positive, negative, or equivocal). RESULTS A total of 728 children with a median age 11.7 (IQR 7.8-14.9) years were studied; 29% had appendicitis. The negative predictive value of US decreased with increasing PAS-based risk assignment: low risk 1.00 (95% CI, 0.97-1.00), medium risk 0.94 (0.91-0.97), and high risk 0.81 (0.73-0.89). With increasing PAS, the positive predictive value increased: low risk 0.73 (0.47-0.99), medium risk 0.90 (0.82-0.98), and high risk 0.97 (0.95-1.0). Among children with equivocal ultrasound results, the proportion with appendicitis ranged from 0.09 (0.0-0.19) for low-risk patients to 0.47 (0.33-0.61) among for high-risk patients. CONCLUSION Ultrasound findings in children with possible appendicitis should be integrated with clinical assessment, such as a clinical score, to determine next steps in management. Rates of false-negative US increase with increasing PAS, and false-positive US results occur more often with lower PAS. When discordance exists between US results and the clinical assessment, serial examinations or further imaging are warranted.
Collapse
Affiliation(s)
- Richard G Bachur
- Division of Emergency Medicine, Boston Children's Hospital and Harvard Medical School, Boston, MA.
| | - Michael J Callahan
- Department of Radiology, Boston Children's Hospital and Harvard Medical School, Boston, MA
| | - Michael C Monuteaux
- Division of Emergency Medicine, Boston Children's Hospital and Harvard Medical School, Boston, MA
| | - Shawn J Rangel
- Department of Surgery, Boston Children's Hospital and Harvard Medical School, Boston, MA
| |
Collapse
|
30
|
Furuya T, Inoue M, Sugito K, Goto S, Kawashima H, Kaneda H, Masuko T, Ohashi K, Ikeda T, Koshinaga T. Effectiveness of Interval Appendectomy After Conservative Treatment of Pediatric Ruptured Appendicitis with Abscess. Indian J Surg 2014; 77:1041-4. [PMID: 27011507 DOI: 10.1007/s12262-014-1121-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2014] [Accepted: 06/09/2014] [Indexed: 12/27/2022] Open
Abstract
The management of patients with acute perforated appendicitis with abscess is controversial. The aim of the present study was to assess the outcomes of treatment in patients with this condition. We retrospectively analyzed 31 patients (16 men and 15 women with a mean age of 8.4 years) with appendicitis presenting with abscess. Patients were divided into two groups (emergency operation group and interval operation group), and clinical characteristics and outcomes of treatment were investigated. On presentation, no differences in gender, age, body weight, duration of symptoms, temperature, white blood cell count, C-reactive protein level, or maximum size of the abscess in the axial view were detected between the two groups. Fifteen patients (48.4 %) underwent emergency surgery. The remaining 16 patients (51.6 %) were initially treated conservatively with antibiotics. All 16 patients underwent planned operations after receiving conservative treatment, and two (12.5 %) of these patients underwent appendectomy before the planned operation day because of recurrent appendicitis without abscess. There were no differences in the length of hospital stay. In the emergency operation group, six (40 %) patients presented with wound infection and four (26.7 %) developed a postoperative intra-abdominal abscess. No infective complications were reported in the interval operation group. Interval appendectomy after conservative treatment of pediatric ruptured appendicitis with abscess significantly reduced postoperative infection rates.
Collapse
Affiliation(s)
- Takeshi Furuya
- Department of Pediatric Surgery, Nihon University School of Medicine, 30-1, Ohyaguchi-Kamicho, Itabashi-ku, Tokyo 173-8610 Japan
| | - Mikiya Inoue
- Department of Pediatric Surgery, Nihon University School of Medicine, 30-1, Ohyaguchi-Kamicho, Itabashi-ku, Tokyo 173-8610 Japan ; Department of Pediatric Surgery, Teikyo University School of Medicine, Itabashi, Japan
| | - Kiminobu Sugito
- Department of Pediatric Surgery, Nihon University School of Medicine, 30-1, Ohyaguchi-Kamicho, Itabashi-ku, Tokyo 173-8610 Japan
| | - Shumpei Goto
- Department of Pediatric Surgery, Nihon University School of Medicine, 30-1, Ohyaguchi-Kamicho, Itabashi-ku, Tokyo 173-8610 Japan
| | - Hiroyuki Kawashima
- Department of Pediatric Surgery, Nihon University School of Medicine, 30-1, Ohyaguchi-Kamicho, Itabashi-ku, Tokyo 173-8610 Japan
| | - Hide Kaneda
- Department of Pediatric Surgery, Nihon University School of Medicine, 30-1, Ohyaguchi-Kamicho, Itabashi-ku, Tokyo 173-8610 Japan
| | - Takayuki Masuko
- Department of Pediatric Surgery, Nihon University School of Medicine, 30-1, Ohyaguchi-Kamicho, Itabashi-ku, Tokyo 173-8610 Japan
| | - Kensuke Ohashi
- Department of Pediatric Surgery, Nihon University School of Medicine, 30-1, Ohyaguchi-Kamicho, Itabashi-ku, Tokyo 173-8610 Japan
| | - Taro Ikeda
- Department of Pediatric Surgery, Nihon University School of Medicine, 30-1, Ohyaguchi-Kamicho, Itabashi-ku, Tokyo 173-8610 Japan
| | - Tsugumichi Koshinaga
- Department of Pediatric Surgery, Nihon University School of Medicine, 30-1, Ohyaguchi-Kamicho, Itabashi-ku, Tokyo 173-8610 Japan
| |
Collapse
|
31
|
Predictive factors for failure of nonoperative management in perforated appendicitis. J Trauma Acute Care Surg 2014; 76:976-81. [DOI: 10.1097/ta.0000000000000187] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
|
32
|
Partecke LI, Müller A, Kessler W, Diedrich S, Heidecke CD, Patrzyk M, Mensel B. [Modern treatment of an appendiceal mass]. Chirurg 2014; 85:622-7. [PMID: 24449081 DOI: 10.1007/s00104-013-2657-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND The recommendations for the treatment of an appendiceal mass are still controversial. The need for staged appendectomy is still under discussion. PATIENTS AND METHODS In a retrospective study all patients with the diagnosis appendiceal mass (ICD 10 K35.32) treated in the surgical clinic of the University Clinic in Greifswald between June 1999 and June 2011 were analyzed. RESULTS A total of 38 patients were included in the study whereby 17 patients (9 male and 8 female) were treated with drainage and antibiotics (group A) and 21 (14 male and 7 female) were treated by immediate surgery (group B). Nonsurgical therapy with drainage of the abscess was found to be efficient. Immediate surgical treatment was also effective and should be performed when signs of peritonitis exist. Interval appendectomy is not indicated.
Collapse
Affiliation(s)
- L I Partecke
- Klinik für Chirurgie, Abteilung für Allgemeine-, Viszeral-, Thorax- und Gefäßchirurgie, Universitätsmedizin Greifswald, Ferdinand Sauerbruchstr., 17475, Greifswald, Deutschland,
| | | | | | | | | | | | | |
Collapse
|
33
|
Yazawa S, Mizuno R, Kaneko G, Ochiai H, Oya M. A case of perforated appendicitis during temsirolimus treatment for metastatic renal cell carcinoma. Int Cancer Conf J 2014. [DOI: 10.1007/s13691-013-0116-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
|
34
|
Tannoury J, Abboud B. Treatment options of inflammatory appendiceal masses in adults. World J Gastroenterol 2013; 19:3942-3950. [PMID: 23840138 PMCID: PMC3703180 DOI: 10.3748/wjg.v19.i25.3942] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2013] [Revised: 03/22/2013] [Accepted: 04/28/2013] [Indexed: 02/06/2023] Open
Abstract
At present, the treatment of choice for uncomplicated acute appendicitis in adults continues to be surgical. The inflammation in acute appendicitis may sometimes be enclosed by the patient’s own defense mechanisms, by the formation of an inflammatory phlegmon or a circumscribed abscess. The management of these patients is controversial. Immediate appendectomy may be technically demanding. The exploration often ends up in an ileocecal resection or a right-sided hemicolectomy. Recently, the conditions for conservative management of these patients have changed due to the development of computed tomography and ultrasound, which has improved the diagnosis of enclosed inflammation and made drainage of intra-abdominal abscesses easier. New efficient antibiotics have also given new opportunities for nonsurgical treatment of complicated appendicitis. The traditional management of these patients is nonsurgical treatment followed by interval appendectomy to prevent recurrence. The need for interval appendectomy after successful nonsurgical treatment has recently been questioned because the risk of recurrence is relatively small. After successful nonsurgical treatment of an appendiceal mass, the true diagnosis is uncertain in some cases and an underlying diagnosis of cancer or Crohn’s disease may be delayed. This report aims at reviewing the treatment options of patients with enclosed appendiceal inflammation, with emphasis on the success rate of nonsurgical treatment, the need for drainage of abscesses, the risk of undetected serious disease, and the need for interval appendectomy to prevent recurrence.
Collapse
|
35
|
Wray CJ, Kao LS, Millas SG, Tsao K, Ko TC. Acute appendicitis: controversies in diagnosis and management. Curr Probl Surg 2013; 50:54-86. [PMID: 23374326 DOI: 10.1067/j.cpsurg.2012.10.001] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
|
36
|
Nixon M, Verwey J, Akoh JA. Caecal tumour masquerading as an appendicular mass. Clin Pract 2012; 2:e4. [PMID: 24765403 PMCID: PMC3981336 DOI: 10.4081/cp.2012.e4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2011] [Revised: 11/29/2011] [Accepted: 12/05/2011] [Indexed: 11/23/2022] Open
Abstract
Appropriate management of appendix mass is based on an accurate diagnosis of the underlying pathology. This is a report of a complex patient presenting with an appendix mass, whose surgery was deferred due to severe co-morbidities and who later died from severe metastatic disease. A 65-year-old lady presented with right iliac fossa pain and a mass. She was treated for an appendix mass initially and when the mass failed to resolve after four weeks, she was thoroughly investigated for the possibility of a tumour. Severe co-morbities had a significant impact on her management as definitive surgery was delayed. She represented 10 months after the initial admission with small bowel obstruction and died of metastatic caecal cancer. Management of appendix mass must entail a careful approach to investigating and treatment with emphasis on early intervention if the mass does not resolve promptly. This will avoid delayed diagnosis, treatment and a detrimental impact on prognosis.
Collapse
Affiliation(s)
- Martha Nixon
- Gastroenterology, Surgery & Renal Services Directorate, Plymouth Hospitals NHS Trust, Derriford Hospital, Plymouth, UK
| | - Jes Verwey
- Gastroenterology, Surgery & Renal Services Directorate, Plymouth Hospitals NHS Trust, Derriford Hospital, Plymouth, UK
| | - Jacob A Akoh
- Gastroenterology, Surgery & Renal Services Directorate, Plymouth Hospitals NHS Trust, Derriford Hospital, Plymouth, UK
| |
Collapse
|
37
|
Meshikhes AWN. Appendiceal mass: Is interval appendicectomy “something of the past”? World J Gastroenterol 2011; 17:2977-80. [PMID: 21799642 PMCID: PMC3132247 DOI: 10.3748/wjg.v17.i25.2977] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2010] [Revised: 01/29/2011] [Accepted: 02/05/2011] [Indexed: 02/06/2023] Open
Abstract
The need for interval appendicectomy (I.A) after successful conservative management of appendiceal mass has recently been questioned. Furthermore, emergency appendicectomy for appendiceal mass is increasingly performed with equal success and safety to that performed in non-mass forming acute appendicitis. There is an increasing volume of evidence -although mostly retrospective- that if traditional conservative management is adopted, there is no need for routine I.A except for a small number of patients who continue to develop recurrent symptoms. On the other hand, the routine adoption of emergency laparoscopic appendicectomy (LA) in patients presenting with appendiceal mass obviates the need for a second admission and an operation for I.A with a considerable complication rate. It also abolishes misdiagnoses and deals promptly with any unexpected ileo-cecal pathology. Moreover, it may prove to be more cost-effective than conservative treatment even without I.A due to a much shorter hospital stay and a shorter period of intravenous antibiotic administration. If emergency LA is to become the standard of care for appendiceal mass, I.A will certainly become ‘something’ of the past.
Collapse
|
38
|
Lien WC, Lee WC, Wang HP, Chen YC, Liu KL, Chen CJ. Male Gender is a Risk Factor for Recurrent Appendicitis Following Nonoperative Treatment. World J Surg 2011; 35:1636-42. [DOI: 10.1007/s00268-011-1132-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
|
39
|
Is interval appendicectomy justified after successful nonoperative treatment of an appendix mass in children? A systematic review. J Pediatr Surg 2011; 46:767-771. [PMID: 21496553 DOI: 10.1016/j.jpedsurg.2011.01.019] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2010] [Revised: 01/07/2011] [Accepted: 01/18/2011] [Indexed: 12/11/2022]
Abstract
BACKGROUND/PURPOSE Interval appendicectomy (IA) is commonly performed after successful nonoperative treatment of appendix mass (AM); although, this approach has recently been challenged. We systematically reviewed the pediatric literature with regard to the justification for this practice. METHODS Using a defined search strategy, studies were identified and data were extracted independently by 2 reviewers. Incidences of recurrent appendicitis, complications after IA, and carcinoid tumor were estimated accounting for interstudy heterogeneity. Cost and length of stay of IA were analyzed. RESULTS Three studies (127 cases) reporting routine nonsurgical treatment were identified; all were retrospective. There was marked interstudy heterogeneity and variable follow-up. After successful nonoperative treatment of AM, the risk of recurrent appendicitis is 20.5% (95% confidence interval [CI], 14.3%-28.4%). The incidence of complications after IA (23 studies, n = 1247) is 3.4% (95% CI, 2.2-5.1), and the incidence of carcinoid tumor found at IA (15 studies, n = 955) is 0.9% (95% CI, 0.5-1.8). No reports compared costs. Mean length of stay for IA was 3 days (range, 1-30 days). CONCLUSIONS Prospective studies comparing routine IA with nonoperative treatment without IA in children are lacking. Available data suggest that 80% of children with AM may not need IA. A prospective study to evaluate the natural history of this condition compared with the morbidity and costs of IA is warranted.
Collapse
|
40
|
Kim JK, Ryoo S, Oh HK, Kim JS, Shin R, Choe EK, Jeong SY, Park KJ. Management of appendicitis presenting with abscess or mass. JOURNAL OF THE KOREAN SOCIETY OF COLOPROCTOLOGY 2010; 26:413-9. [PMID: 21221242 PMCID: PMC3017977 DOI: 10.3393/jksc.2010.26.6.413] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/24/2010] [Accepted: 10/12/2010] [Indexed: 12/19/2022]
Abstract
Purpose Management strategy in acute appendicitis patients initially presenting with abscess or mass is surrounded with controversy. This study was performed to identify the outcomes of management for this condition. Methods We retrospectively analyzed prospectively registered 76 patients (male:female = 39:37; mean age, 50.8 years) with appendicitis presenting with abscess or mass over a 9-year period at the Seoul National University Hospital. Patients were divided into three groups (emergency operation group, delayed operation group, and follow-up group), and clinical characteristics and outcomes of treatment were investigated. Results Twenty-eight patients (36.8%) underwent an emergency operation. Of the remaining 48 patients, 20 (41.7%) were initially treated with conservative management through the use of antibiotics only; the other 28 (58.3%) with and additional ultrasound-guided percutaneous drainage of the abscess. Twenty-six (54.2%) patients underwent planned operations after conservative management, and 22 (45.8%) were followed without surgery (median duration, 37.8 month), of which 3 (13%) underwent an appendectomy due to recurrent appendicitis (mean of 56.7 days after initial attack). There were no statistical differences in types of operation performed (appendectomy or ileocecectomy), postoperative complications, and postoperative hospital stay among the patients who underwent emergency operations, delayed operations and operations for recurrence during follow-up. Conclusion Although the recurrence rate was relatively low after conservative management for appendicitis patients presenting with abscess or mass, there was no difference in surgical outcome between the emergent, elective, or recurrent groups. Our results indicate that proper management of appendicitis with abscess or mass can be selected according to surgeon's preference.
Collapse
Affiliation(s)
- Jeong-Ki Kim
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
| | | | | | | | | | | | | | | |
Collapse
|
41
|
Lee SL, Islam S, Cassidy LD, Abdullah F, Arca MJ. Antibiotics and appendicitis in the pediatric population: an American Pediatric Surgical Association Outcomes and Clinical Trials Committee systematic review. J Pediatr Surg 2010; 45:2181-5. [PMID: 21034941 DOI: 10.1016/j.jpedsurg.2010.06.038] [Citation(s) in RCA: 81] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2010] [Revised: 06/21/2010] [Accepted: 06/25/2010] [Indexed: 12/23/2022]
Abstract
OBJECTIVE The aim of the study was to review evidence-based data regarding the use of antibiotics for the treatment of appendicitis in children. DATA SOURCE Data were obtained from PubMed, MEDLINE, and citation review. STUDY SELECTION We conducted a literature search using "appendicitis" combined with "antibiotics" with children as the target patient population. Studies were selected based on relevance for the following questions: (1) What perioperative antibiotics should be used for pediatric patients with nonperforated appendicitis? (2) For patients with perforated appendicitis treated with appendectomy: a. What perioperative intravenous antibiotics should be used? b. How long should perioperative intravenous antibiotics be used? c. Should oral antibiotics be used? (3) For patients with perforated appendicitis treated with initial nonoperative management, what antibiotics should be used in the initial management? RESULTS Children with nonperforated appendicitis should receive preoperative, broad-spectrum antibiotics. In children with perforated appendicitis who had undergone appendectomy, intravenous antibiotic duration should be based on clinical criteria. Furthermore, broad-spectrum, single, or double agent therapy is as equally efficacious as but is more cost-effective than triple agent therapy. If intravenous antibiotics are administered for less than 5 days, oral antibiotics should be administered for a total antibiotic course of 7 days. For children with perforated appendicitis who did not initially undergo an appendectomy, the duration of broad-spectrum, intravenous antibiotics should be based on clinical symptoms. CONCLUSIONS Current evidence supports the use of guidelines as described above for antibiotic therapy in children with acute and perforated appendicitis.
Collapse
Affiliation(s)
- Steven L Lee
- Division of Pediatric Surgery, David Geffen School of Medicine at UCLA and Harbor-UCLA Medical Center, Box 709818, Los Angeles, CA 90095, USA.
| | | | | | | | | | | |
Collapse
|
42
|
Evaluation of early surgical management of complicated appendicitis by appendicular mass. Int J Surg 2010; 9:101-3. [PMID: 20965290 DOI: 10.1016/j.ijsu.2010.10.006] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2010] [Accepted: 10/11/2010] [Indexed: 11/22/2022]
Abstract
AIM This prospective study was done to evaluate the feasibility and safety of immediate appendicectomy in the presence of appendicular mass. METHODS A prospective, nonrandomized study was conducted over 46 consecutive patients (mean age: 24 ± 8.76 years) presenting with an appendicular mass over a 4-year period. They were subjected for immediate appendicectomy within 24 h of admission. RESULTS The appendix was identified and removed in all 46 patients at operation. Peri-appendiceal abscesses were present in 25% (11 of 46). There was difficulty with adhesolysis and localization of the appendix in 10%(4) of patients. Superficial wound infection had occurred in 8(17%) while deep wound infection had occurred in 9%(4) patients. The mean hospital stay was 3 ± 0.25 day. No major complications had occurred. CONCLUSIONS Early surgical intervention in patients with an appendicular mass is feasible, safe and avoids the consequences of the misdiagnosis and mistreatment of other surgical pathologies.
Collapse
|
43
|
Yayla D, Alpman BN, Dolek Y. Granulomatous appendicitis in a 12-year-old boy. J Pediatr Surg 2010; 45:e27-9. [PMID: 20850613 DOI: 10.1016/j.jpedsurg.2010.06.017] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2009] [Revised: 06/01/2010] [Accepted: 06/07/2010] [Indexed: 12/21/2022]
Abstract
Isolated granulomatous inflammation of the appendix is extremely rare, and its etiology is still unknown. We describe a 12-year-old boy with isolated granulomatous appendicitis where the etiology could not be clarified despite infectious criteria such as high fever and gastroenteritis. Children with epithelioid granulomatous appendicitis have a good prognosis following appendectomy.
Collapse
Affiliation(s)
- Derya Yayla
- Department of Pediatrics Surgery, Cankiri State Hospital, 18200 Cankiri, Turkey.
| | | | | |
Collapse
|
44
|
Simillis C, Symeonides P, Shorthouse AJ, Tekkis PP. A meta-analysis comparing conservative treatment versus acute appendectomy for complicated appendicitis (abscess or phlegmon). Surgery 2010; 147:818-29. [PMID: 20149402 DOI: 10.1016/j.surg.2009.11.013] [Citation(s) in RCA: 159] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2007] [Accepted: 11/20/2009] [Indexed: 02/09/2023]
Abstract
BACKGROUND No standardized approach is available for the management of complicated appendicitis defined as appendiceal abscess and phlegmon. This study used meta-analytic techniques to compare conservative treatment versus acute appendectomy. METHODS Comparative studies were identified by a literature search. The end points evaluated were overall complications, need for reoperation, duration of hospital stay, and duration of intravenous antibiotics. Heterogeneity was assessed and a sensitivity analysis was performed to account for bias in patient selection. RESULTS Seventeen studies (16 nonrandomized retrospective and 1 nonrandomized prospective) reported on 1,572 patients: 847 patients received conservative treatment and 725 had acute appendectomy. Conservative treatment was associated with significantly less overall complications, wound infections, abdominal/pelvic abscesses, ileus/bowel obstructions, and reoperations. No significant difference was found in the duration of first hospitalization, the overall duration of hospital stay, and the duration of intravenous antibiotics. Overall complications remained significantly less in the conservative treatment group during sensitivity analysis of studies including only pediatric patients, high-quality studies, more recent studies, and studies with a larger group of patients. CONCLUSION The conservative management of complicated appendicitis is associated with a decrease in complication and reoperation rate compared with acute appendectomy, and it has a similar duration of hospital stay. Because of significant heterogeneity between studies, additional studies should be undertaken to confirm these findings.
Collapse
|
45
|
Solomkin JS, Mazuski JE, Bradley JS, Rodvold KA, Goldstein EJC, Baron EJ, O'Neill PJ, Chow AW, Dellinger EP, Eachempati SR, Gorbach S, Hilfiker M, May AK, Nathens AB, Sawyer RG, Bartlett JG. Diagnosis and management of complicated intra-abdominal infection in adults and children: guidelines by the Surgical Infection Society and the Infectious Diseases Society of America. Surg Infect (Larchmt) 2010; 11:79-109. [PMID: 20163262 DOI: 10.1089/sur.2009.9930] [Citation(s) in RCA: 304] [Impact Index Per Article: 21.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Evidence-based guidelines for managing patients with intra-abdominal infection were prepared by an Expert Panel of the Surgical Infection Society and the Infectious Diseases Society of America. These updated guidelines replace those previously published in 2002 and 2003. The guidelines are intended for treating patients who either have these infections or may be at risk for them. New information, based on publications from the period 2003-2008, is incorporated into this guideline document. The panel has also added recommendations for managing intra-abdominal infection in children, particularly where such management differs from that of adults; for appendicitis in patients of all ages; and for necrotizing enterocolitis in neonates.
Collapse
Affiliation(s)
- Joseph S Solomkin
- Department of Surgery, the University of Cincinnati College of Medicine, 231 Albert B. Sabin Way, Cincinnati, OH 45267-0558, USA.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
46
|
Solomkin JS, Mazuski JE, Bradley JS, Rodvold KA, Goldstein EJ, Baron EJ, O'Neill PJ, Chow AW, Dellinger EP, Eachempati SR, Gorbach S, Hilfiker M, May AK, Nathens AB, Sawyer RG, Bartlett JG. Diagnosis and Management of Complicated Intra-abdominal Infection in Adults and Children: Guidelines by the Surgical Infection Society and the Infectious Diseases Society of America. Clin Infect Dis 2010; 50:133-64. [PMID: 20034345 DOI: 10.1086/649554] [Citation(s) in RCA: 954] [Impact Index Per Article: 68.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Abstract
Evidence-based guidelines for managing patients with intra-abdominal infection were prepared by an Expert Panel of the Surgical Infection Society and the Infectious Diseases Society of America. These updated guidelines replace those previously published in 2002 and 2003. The guidelines are intended for treating patients who either have these infections or may be at risk for them. New information, based on publications from the period 2003–2008, is incorporated into this guideline document. The panel has also added recommendations for managing intra-abdominal infection in children, particularly where such management differs from that of adults; for appendicitis in patients of all ages; and for necrotizing enterocolitis in neonates.
Collapse
Affiliation(s)
- Joseph S. Solomkin
- Department of Surgery, the University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - John E. Mazuski
- Department of Surgery, Washington University School of Medicine, Saint Louis, Missouri
| | | | - Keith A Rodvold
- Department of Pharmacy Practice, Chicago
- Department of Medicine, University of Illinois at Chicago, Chicago
| | - Ellie J.C. Goldstein
- R. M. Alden Research Laboratory, David Geffen School of Medicine at UCLA, Los Angeles
| | - Ellen J. Baron
- Department of Pathology, Stanford University School of Medicine, Palo Alto, California
| | - Patrick J. O'Neill
- Department of Surgery, The Trauma Center at Maricopa Medical Center, Phoenix, Arizona
| | - Anthony W. Chow
- Department of Medicine, University of British Columbia, Vancouver, British Columbia
| | | | | | - Sherwood Gorbach
- Department of Medicine, Tufts University School of Medicine, Boston, Massachusetts
| | - Mary Hilfiker
- Department of Surgery, Rady Children's Hospital of San Diego, San Diego
| | - Addison K. May
- Department of Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | | | | | - John G. Bartlett
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| |
Collapse
|
47
|
Gosain A, Williams RF, Blakely ML. Distinguishing acute from ruptured appendicitis preoperatively in the pediatric patient. Adv Surg 2010; 44:73-85. [PMID: 20919515 DOI: 10.1016/j.yasu.2010.05.021] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Affiliation(s)
- Ankush Gosain
- Division of Pediatric Surgery, Department of Surgery, University of Tennessee Health Sciences Center, 777 Washington Avenue, Suite P220, Memphis, TN 38105, USA
| | | | | |
Collapse
|
48
|
IPEG guidelines for appendectomy. J Laparoendosc Adv Surg Tech A 2009; 19 Suppl 1:vii-ix. [PMID: 19371152 DOI: 10.1089/lap.2009.9983.supp] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
|
49
|
Abstract
BACKGROUND The management of appendiceal mass is surrounded with controversy. Traditional management has been conservative, with interval appendicectomy performed weeks after the mass had resolved. This remains the most common approach at many centers in the world. Recently, an increasing number of studies have challenged this approach. This article reviews some of the controversial issues in the management of appendix mass, assesses current practice and suggests an appropriate approach for the management of appendix mass. METHODS A Medline, Pubmed and Cochrane database search were used to find such key words and combinations of: appendix, appendiceal, appendicular, interval, appendectomy, appendicectomy, mass, abscess, phlegmon, and appendicitis. Results were saved and managed by Reference manager 11. All articles were cross-referenced by the authors. RESULTS A conservative management is still a highly acceptable approach for appendix mass. This should be followed with interval appendicectomy especially in patients with persistent right iliac fossa pain. CONCLUSION We recommend initially conservative approach to the management of appendiceal mass especially in our environment.
Collapse
Affiliation(s)
- E S Garba
- Division of General Surgery, Department of Surgery, Ahmadu Bello University Teaching Hospital Zaria, Nigeria.
| | | |
Collapse
|
50
|
|