The role of screening colonoscopy after appendicitis in patients over 40 years of age

Diagnostic efficacy of ultrasound and computed tomography for acute appendicitis: A single center retrospective study

The aim of this study was to evaluate the diagnostic efficacy of ultrasonography (US) and computed tomography (CT) examination for acute appendicitis (AA). A total of 41 patients with suspected AA were enrolled in this study. CT scan was performed in 24 patients, and US was performed in 17 patients. Both CT scan and US were performed in 7 patients. The primary outcomes were the performance characteristics (sensitivity, specificity) of US and CT in the patients with suspected AA. The secondary outcomes included the diagnostic accuracy of CT and US. By using US, 6 patients (35%) were incorrectly diagnosed and 2 other patients (12%) had equivocal results. By using CT as the primary diagnostic tool, 4 patients (17%) were misdiagnosed and 8 patients (33%) had equivocal results. Even if the equivocal results of CT and US were excluded from the calculation, the sensitivity and specificity of CT was 88% and 71% respectively, while the sensitivity and specificity of US was 73% and 50%, respectively. Although CT and US are believed to be reliable diagnostic tool to precisely diagnose AA. The rate of negative appendectomy still remains high. There is a need to develop a more accurate methods to diagnose AA, and therefore rate of negative appendectomy can be reduced.

Colorectal screening following appendectomy in adult patients: a systematic review

PURPOSE

Although the association between appendicitis and colorectal cancer in older patients has received attention, postoperative colorectal screening through endoscopy is not currently recommended. This study conducted a systematic review of the literature on colorectal screening following appendectomy in adult patients.

METHODS

A literature search was performed using online databases. Studies reporting colorectal surveillance after appendectomy in adult patients were retrieved for assessment.

RESULTS

Eight articles including a total of 3,995 patients were published between 2013 and 2023. An age of 40 years was the lower threshold in 6 of the 8 articles. Postoperative colorectal screening occurred in 771 patients (19.3%). Endoscopy was performed in 95.2% of cases and computed tomography-colonography in 4.8%. During endoscopic examinations, a lesion was discovered in 184 of 771 patients (24.0%), and an adenomatous polyp was found in 154 of 686 patients (22.5%). The overall cancer rate was 3.9% (30 of 771 patients). The tumor was located in the right-sided colon in 46.7% of the patients, in the cecum in 20.0%, in the rectum in 16.7%, in the left-sided colon in 10.0%, and in the sigmoid colon in 6.7%.

CONCLUSION

Performing post-appendectomy colorectal screening in patients >40 years of age could allow early detection of an underlying lesion.

Elevated Colon Cancer Rates Linked to Prior Appendicitis: A Retrospective Cohort Study Based on Data from German General Practices

Background/Objective: The association between appendicitis and colon cancer is not yet fully understood. Previous studies have shown contradictory results. Currently, no population-based data from Germany are available with regard to the incidence of colon cancer following appendicitis. This study investigated the association between appendicitis and the incidence of colon cancer in Germany. Methods: In this retrospective cohort study, the incidence of colon cancer was compared for patients with appendicitis and patients without appendicitis, matched for age, sex, index year, average annual consultation frequency, and comorbidity. The aim of the study was to explore the relationship between appendicitis and the incidence of colon cancer. The evaluation was carried out using logistic regression analyses. Results: The study included 49,790 people with and without appendicitis, with a median age of 41 years. During a follow-up period of up to 15 years, 1.04% of cases with appendicitis and 0.60% of cases without appendicitis were newly diagnosed with colon cancer, with some 36.4% of colon cancer cases diagnosed within the first six months after appendicitis. Regression analyses revealed a significant association between appendicitis and colon cancer, particularly in men and in the age groups 41-50 (HR: 10.30; 95% CI: 1.03-43.82) and 18-30 years (HR: 8.17; 95% CI: 1.03-64.58). Conclusions: The present retrospective cohort study suggests an association between appendicitis and the incidence of colon cancer in Germany. Based on our results, we recommend offering a colonoscopy or at least a stool test within 12 months after appendicitis, especially for 18-50-year-olds and >60-year-olds in good general health.

Can Salmonella typhi Cause Acute Appendicitis?

Salmonella typhi, commonly known for causing typhoid fever, is recognized as a bacterium responsible for a wide range of gastrointestinal and systemic infections. While its systemic manifestations have been well-documented, its association with localized gastrointestinal complications, such as appendicitis, remains relatively rare and less explored. This case report presents a compelling clinical case of a 55-year-old patient who presented with symptoms of gastrointestinal distress and was diagnosed with S. typhi-induced appendicitis. The patient's history, clinical presentation, laboratory investigations, radiological findings, management, and outcomes are thoroughly discussed. The report also touches upon the broader context of appendicitis etiology and highlights the significance of prompt diagnosis and intervention in cases of Salmonella-induced appendicitis.