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Zouari M, Hbaieb M, Issaoui A, Krichen E, Safi F, Dhaou MB, Mhiri R. Ultrasound Assessment in Children With Suspected Appendicitis: Time to Revise Diagnostic Criteria: A Prospective Cohort Study. Surg Infect (Larchmt) 2024. [PMID: 38625002 DOI: 10.1089/sur.2023.370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/17/2024] Open
Abstract
Background: Although ultrasound is considered the gold standard for the evaluation of children with suspected appendicitis, there is still much debate about the most accurate ultrasound findings. The purpose of this study was to define the best ultrasound signs that could ultimately improve the diagnostic accuracy of ultrasound for diagnosing pediatric acute appendicitis, and to differentiate between simple appendicitis and complicated appendicitis. Patients and Methods: After approval by our Institutional Review Board, a prospective study was carried out from January 1, 2022, to July 31, 2023, in a pediatric emergency department. We included all patients aged under 14 years with suspected appendicitis and ultrasound-visualized appendix. Results: A total of 550 patients presented with suspected appendicitis during the study period. Of these children, 411 had an ultrasound-visualized appendix. Our patients' mean age was 9.4 years. The best positive predictive value of ultrasound was found for appendiceal diameter ≥7.5 mm. The combination of an appendiceal diameter <6 mm and the lack of peri-appendiceal free fluid on ultrasound rules out the diagnosis of appendicitis. The best diagnostic accuracy of ultrasound, which was 92%, was achieved for appendix diameters ≥6.5 mm. The sonographic sign giving the best ultrasound accuracy for diagnosing complicated appendicitis was an appendix diameter ≥9 mm. Conclusions: In conclusion, our present study demonstrated that appendiceal diameter ≥6.5 mm is the gold standard for diagnosing appendicitis in pediatric patients. The combination of an appendiceal diameter <6 mm and the lack of peri-appendiceal free fluid on ultrasound would rule out appendicitis.
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Affiliation(s)
- Mohamed Zouari
- Research Laboratory "Developmental and Induced Diseases" (LR19ES12), Faculty of Medicine of Sfax, University of Sfax, Sfax, Tunisia
- Department of Pediatric Surgery, Hedi Chaker Hospital, Sfax, Tunisia
| | - Manar Hbaieb
- Research Laboratory "Developmental and Induced Diseases" (LR19ES12), Faculty of Medicine of Sfax, University of Sfax, Sfax, Tunisia
- Department of Pediatric Surgery, Hedi Chaker Hospital, Sfax, Tunisia
| | - Asma Issaoui
- Research Laboratory "Developmental and Induced Diseases" (LR19ES12), Faculty of Medicine of Sfax, University of Sfax, Sfax, Tunisia
- Department of Pediatric Surgery, Hedi Chaker Hospital, Sfax, Tunisia
| | - Emna Krichen
- Research Laboratory "Developmental and Induced Diseases" (LR19ES12), Faculty of Medicine of Sfax, University of Sfax, Sfax, Tunisia
- Department of Pediatric Surgery, Hedi Chaker Hospital, Sfax, Tunisia
| | - Faiza Safi
- Department of Pediatrics, Hedi Chaker Hospital, Sfax, Tunisia
| | - Mahdi Ben Dhaou
- Research Laboratory "Developmental and Induced Diseases" (LR19ES12), Faculty of Medicine of Sfax, University of Sfax, Sfax, Tunisia
- Department of Pediatric Surgery, Hedi Chaker Hospital, Sfax, Tunisia
| | - Riadh Mhiri
- Research Laboratory "Developmental and Induced Diseases" (LR19ES12), Faculty of Medicine of Sfax, University of Sfax, Sfax, Tunisia
- Department of Pediatric Surgery, Hedi Chaker Hospital, Sfax, Tunisia
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2
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Kobayashi K, Umekawa Y. Successful Gastrografin Vermifugation for Taenia saginata-associated Appendicitis. Intern Med 2024:3582-24. [PMID: 38599859 DOI: 10.2169/internalmedicine.3582-24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/12/2024] Open
Abstract
In Japan, public health improvements have lessened parasitic infections, but increased global travel has introduced new disease risks. We report the case a Japanese man who had previously resided in Vietnam, who experienced appendicitis and the presence of segments in his stool. Gastrografin led to the expulsion of Taenia saginata, as confirmed by scolex identification. Remarkably, the appendicitis symptoms subsided after deworming. This case underscores the importance of considering cestode infections in the differential diagnosis of appendicitis, particularly for patients with relevant travel histories, and highlights the evolving challenges in global health and the significance of acquiring detailed patient histories.
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Affiliation(s)
- Keigo Kobayashi
- Department of Internal Medicine, Kurashiki Medical Center, Japan
| | - Yasuhiro Umekawa
- Department of Internal Medicine, Kurashiki Medical Center, Japan
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Gal M, Maya P, Ofer K, Mansoor K, Benyamine A, Boris K. Acute Appendicitis in the Elderly: A Nationwide Retrospective Analysis. J Clin Med 2024; 13:2139. [PMID: 38610904 PMCID: PMC11012554 DOI: 10.3390/jcm13072139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2024] [Revised: 02/28/2024] [Accepted: 04/03/2024] [Indexed: 04/14/2024] Open
Abstract
Background: Acute appendicitis (AA) in older individuals remains understudied. We aimed to assess AA characteristics in patients older than 60 years and evaluate the impact of comorbidities. Methods: This retrospective study analyzed data from the American National Inpatient Sample between 2016 and 2019 to compare AA characteristics in patients younger and older than 60 years. Results: Of the 538,400 patients included, 27.5% were older than 60 years. Younger patients had a higher appendectomy rate (p < 0.01), while the complicated appendicitis rate was higher in older patients. Superficial wound infection, systemic infection, and mortality rates were higher in older patients (p < 0.01). Risk factors for superficial wound infection in patients younger than 60 years included cerebrovascular disease, chronic kidney disease, hypertension, heart failure, and obesity, whereas only heart failure was a risk factor in older patients. Risk factors for systemic infection in young patients included hypertension, heart failure, obesity, and diabetes mellitus, while in older patients they included hypertension, heart failure, and obesity. Complicated appendicitis was not a risk factor for infections in either group. Conclusions: This study highlights a higher incidence of AA in older individuals than previously reported, with comorbidities posing differing risks for infections between age groups.
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Affiliation(s)
- Malkiely Gal
- Division of Surgery, Hillel Yaffe Medical Center, Hadera 38100, Israel
| | - Paran Maya
- Department of Pediatric and Adolescent Surgery, Schneider Children’s Medical Center, Petah Tikva 4920235, Israel;
| | - Kobo Ofer
- Division of Cardiology, Hillel Yaffe Medical Center, Hadera 38100, Israel
| | - Khan Mansoor
- Department of Major Trauma, Hull University Teaching Hospitals, Hull HU3 2JZ, UK
| | - Abbou Benyamine
- Hospital Administration Hillel Yaffe Medical Center, Hadera 38100, Israel;
- Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa 31096, Israel
| | - Kessel Boris
- Division of Surgery, Hillel Yaffe Medical Center, Hadera 38100, Israel
- Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa 31096, Israel
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Fennell J, Territo HM, Telt N, Wrotniak BH, Kozielski R, Pape E, Penque M. The Association Between C-Reactive Protein Levels and Pediatric Appendicitis Score and the Severity of Appendicitis in Children. J Emerg Med 2024; 66:e508-e515. [PMID: 38429214 DOI: 10.1016/j.jemermed.2023.11.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 11/18/2023] [Accepted: 11/23/2023] [Indexed: 03/03/2024]
Abstract
BACKGROUND Acute appendicitis is a common cause of abdominal pain leading to emergent abdominal surgery in children. C-reactive protein (CRP), an inflammatory marker typically elevated in acute appendicitis, and Pediatric Appendicitis Score (PAS), a clinical scoring system used for the diagnosis of appendicitis, have the potential to predict the severity of inflammation of the appendix. This may be useful in helping the physician make a treatment plan prior to surgery. OBJECTIVE The purpose of this study was to assess whether CRP value and PAS differ with the extent of inflammation of the appendix seen on histologic examination. METHODS This was a prospective observational study of patients diagnosed with acute appendicitis via computed tomography or ultrasound. Enrolled patients had CRP levels drawn, PAS calculated, and appendix pathology reviewed. Appendix pathology was categorized by the pathologist on the basis of the level of inflammation: simple, suppurative, gangrenous, and perforated. RESULTS One hundred sixty-three patients were enrolled. CRP levels and PAS were statistically different (p < 0.002) among the four pathology classifications. Patients with simple appendicitis (n = 3) had a mean CRP of 2.95 mg/L and PAS of 3.9, patients with suppurative appendicitis (n = 99) had a mean CRP of 26.89 mg/L and PAS of 6.5, patients with gangrenous appendicitis (n = 56) had a mean CRP of 91.11 mg/L and PAS of 7.5, and patients with perforated appendicitis (n = 6) had a mean CRP of 154.17 mg/L and PAS of 7. The results remained statistically significant (p < 0.002) after adjusting for age, race, and sex. When combined-PAS ≥ 8 and CRP level > 40 mg/L-the specificity of complicated appendicitis was 91.2% and positive predictive value was 72.7%. CONCLUSIONS Higher CRP levels and PAS were associated with increased histologic inflammation of the appendix. This study provides preliminary evidence that CRP and PAS could potentially assist in treatment decisions for appendicitis.
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Affiliation(s)
- Jill Fennell
- Department of Pediatrics, Division of Pediatric Emergency Medicine, UBMD Pediatrics, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, John R. Oishei Children's Hospital, Buffalo, New York
| | - Heather M Territo
- Department of Pediatrics, Division of Pediatric Emergency Medicine, UBMD Pediatrics, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, John R. Oishei Children's Hospital, Buffalo, New York
| | - Nadya Telt
- Department of Pediatrics, Division of Pediatric Emergency Medicine, UBMD Pediatrics, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, John R. Oishei Children's Hospital, Buffalo, New York
| | - Brian H Wrotniak
- Department of Pediatrics, Division of Pediatric Emergency Medicine, UBMD Pediatrics, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, John R. Oishei Children's Hospital, Buffalo, New York; Masters of Public Health Program, D'Youville College, Buffalo, New York
| | - Rafal Kozielski
- Department of Pathology and Anatomical Sciences, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, John R. Oishei Children's Hospital, Buffalo, New York
| | - Earl Pape
- Department of Pathology and Anatomical Sciences, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, John R. Oishei Children's Hospital, Buffalo, New York
| | - Michelle Penque
- Department of Pediatrics, Division of Pediatric Emergency Medicine, UBMD Pediatrics, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, John R. Oishei Children's Hospital, Buffalo, New York
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Zhang Q, Zhang L, Wu J, Yang F. Effects of clinical nursing pathway on surgical site wound infection in patients undergoing acute appendicitis surgery: A meta-analysis. Int Wound J 2024; 21:e14600. [PMID: 38146201 PMCID: PMC10961861 DOI: 10.1111/iwj.14600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2023] [Revised: 12/07/2023] [Accepted: 12/08/2023] [Indexed: 12/27/2023] Open
Abstract
This study aimed to explore the impact of clinical nursing pathway applied to acute appendicitis surgery on patients' postoperative wound infections and complications. A computerised search of PubMed, Cochrane Library, Web of Science, EMBASE, Wanfang, Chinese Biomedical Literature Database and China National Knowledge Infrastructure was conducted and supplemented by a manual search, from database inception to October 2023, to collect randomised controlled trials (RCTs) on the application of clinical nursing pathways to acute appendicitis surgery. Literature screening, data extraction and quality assessment of the included literature were carried out independently by two researchers. RevMan 5.4 software was applied for data analysis. Twenty-one RCTs with a total of 2408 patients were finally included. The analysis revealed the implementation of clinical nursing pathway could effectively reduce the incidence of wound infection (OR = 0.26, 95% CI: 0.15-0.46, p < 0.001) and postoperative complications (OR = 0.20, 95% CI: 0.15-0.27, p < 0.001), as well as shorten the hospital length of stay (MD = -3.26, 95% CI: -3.74 to -2.79, p < 0.001) and accelerated the time to first ventilations (MD = -14.85, 95% CI: -21.56 to -8.13, p < 0.001), as well as significantly improved patient satisfaction (OR = 5.52, 95% CI: 3.52-8.65, p < 0.001) in patients undergoing surgery for acute appendicitis. The application of clinical nursing pathway in acute appendicitis surgery can significantly reduce postoperative wound infection and complications, and at the same time can shorten the hospital length of stay as well as improve the satisfaction of patients.
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Affiliation(s)
- Qin Zhang
- Department of EmergencyPeople's Hospital Affiliated to Shandong First Medical UniversityJinanChina
| | - Li‐Hua Zhang
- Department of ObstetricsPeople's Hospital Affiliated to Shandong First Medical UniversityJinanChina
| | - Jian‐Li Wu
- Department of OtolaryngologyPeople's Hospital Affiliated to Shandong First Medical UniversityJinanChina
| | - Feng‐Yong Yang
- Department of EmergencyPeople's Hospital Affiliated to Shandong First Medical UniversityJinanChina
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Tazeoglu D, Cem Esmer A. Is LigaSure Alone Sufficient for the Closure of the Appendix Stump? Surg Innov 2024; 31:167-172. [PMID: 38357718 DOI: 10.1177/15533506241234005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2024]
Abstract
PURPOSES Closure of the appendix stump is necessary for laparoscopic appendectomy. Problems that occur during the appendix stump closure can cause severe morbidity. Several methods of stump closure have been described. This study aimed to investigate the adequacy of LigaSure alone in closing the appendix stump. METHODS Patients who were operated on with the diagnosis of acute appendicitis between October 2021 and January 2022 were evaluated retrospectively. The patients were divided into two groups according to the closure technique of the appendix stump hemoclip(group I) and LigaSure only(group II). In addition, demographic data (age, gender), body mass index (BMI), presence of comorbid disease, perioperative appendicitis classification, operation time, postoperative hospital stay, radiological and pathological appendix size of the patients included in the study were recorded. Clavien Dindo was used for postoperative complication assessment. RESULT The study included 77 patients. 48(62.3%) of the patients were in group I, and 29(37.7%) were in group II. There was no statistical difference between the groups regarding age, gender distribution, BMI, presence of comorbid disease (P > .05). The operation time of group I was longer than group II (P < .001). There was no difference between the groups in terms of both radiological and pathological appendix size. There was no statistical difference between the groups regarding postoperative complications and severity of complications (P = .76, P = .99, respectively). CONCLUSION Appendiceal stump closure can be performed with Ligasure, but it should be noted that this procedure can be performed on selected patients, as in the study group, not on all patients.
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Affiliation(s)
- Deniz Tazeoglu
- Surgical Oncology, Republic of Turkey Ministry of Health Osmaniye State Hospital, Osmaniye, Turkey
| | - Ahmet Cem Esmer
- Department of Surgical Oncology, Antalya City Hospital, Antalya, Turkey
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7
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Liu F, Zhou J, Wu X. Effects of evidence-based nursing on surgical site wound infection in patients undergoing acute appendicitis surgery: A meta-analysis. Int Wound J 2024; 21:e14539. [PMID: 38506317 PMCID: PMC10952117 DOI: 10.1111/iwj.14539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Revised: 11/17/2023] [Accepted: 11/19/2023] [Indexed: 03/21/2024] Open
Abstract
This study aimed to comprehensively evaluate the effects of evidence-based nursing (EBN) intervention on wound infection and postoperative complications in patients after appendectomy for acute appendicitis (AA), with the expectation of providing a theoretical basis for postoperative care in AA. Randomised controlled trials (RCTs) on the postoperative application of EBN in patients with AA were searched in PubMed, Web of Science, Cochrane Library, Embase, China Biomedical Literature Database, Wanfang and China National Knowledge Infrastructure from the inception of databases to October 2023. Two authors screened and evaluated the literature based on the inclusion and exclusion criteria, and data were extracted from the final included literature. Stata software (version 17.0) was employed for data analysis. In total, 29 RCTs involving 2848 patients with AA were included, with 1424 in the EBN group and 1424 in the conventional care group. The analyses revealed that patients with AA who experienced EBN were significantly less likely to develop postoperative wound infections (odds ratio [OR] = 0.23, 95% confidence intervals [CIs]: 0.14-0.38, p < 0.001) and postoperative complications (OR = 0.20, 95% CI: 0.15-0.26, p < 0.001) as opposed to conventional care. Available evidence suggests that EBN can effectively reduce the risk of wound infection and postoperative complications in patients undergoing appendectomy for AA, thereby improving patient prognosis. This finding is worth promoting in the clinical practice.
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Affiliation(s)
- Feng Liu
- Department of EmergencyThe People's Hospital of Chongqing Liangjiang New AreaChongqingChina
| | - Juan Zhou
- Department of General SurgeryThe People's Hospital of Chongqing Liangjiang New AreaChongqingChina
| | - Xue‐Lian Wu
- Department of Child HealthcareThe People's Hospital of Chongqing Liangjiang New AreaChongqingChina
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8
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Dreznik Y, Paran M, Sher C, Konen O, Baazov A, Nica A, Kravarusic D. Negative appendectomy rate in the pediatric population: can we reach near-zero rates? An observational study. ANZ J Surg 2024; 94:204-207. [PMID: 38082452 DOI: 10.1111/ans.18825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Revised: 08/05/2023] [Accepted: 11/21/2023] [Indexed: 02/27/2024]
Abstract
INTRODUCTION Correct diagnosis of acute appendicitis may sometimes be challenging. The Negative appendectomy rate (NAR) has declined in the recent years in Europe and USA, in part due to better diagnostic imaging tools. The aim of this study was to examine the rates of negative appendectomy in our institution, investigate trends in its incidence, and identify possible predicting factors. METHODS A retrospective cohort study, including all patients younger than 18 years of age who underwent an appendectomy between 2007 and 2021 in a single tertiary medical center. Data regarding patient's demographics, laboratory and imaging results, pathological results and clinical outcome were collected. RESULTS Between 2007 and 2021, a total of 3937 pediatric patients underwent appendectomy due to a working diagnosis of acute appendicitis. Overall, 143 patients (3.6%) had normal appendix on pathological examination. However, in the last 5 years, the rate of normal appendix was 1.9%, together with an increased rate of pre-operative imaging (from 40% to nearly 100%). CONCLUSION Low NAR under 2% is an achievable benchmark in the era of accessible pre-operative imaging. In unequivocal cases, a secondary survey that includes repeated physical examination, blood work and imaging is recommended and may result in near-zero rates of NAR.
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Affiliation(s)
- Yael Dreznik
- Department of Pediatric and Adolescent Surgery, Schneider Children's Medical Center of Israel, Petah-Tiqwa, Israel
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Maya Paran
- Department of Pediatric and Adolescent Surgery, Schneider Children's Medical Center of Israel, Petah-Tiqwa, Israel
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Carmel Sher
- Department of Pediatric and Adolescent Surgery, Schneider Children's Medical Center of Israel, Petah-Tiqwa, Israel
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Osnat Konen
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
- The Institute of Imaging, Schneider Children's Medical Center of Israel, Petah-Tiqwa, Israel
| | - Artur Baazov
- Department of Pediatric and Adolescent Surgery, Schneider Children's Medical Center of Israel, Petah-Tiqwa, Israel
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Adrianna Nica
- Department of Pediatric and Adolescent Surgery, Schneider Children's Medical Center of Israel, Petah-Tiqwa, Israel
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Dragan Kravarusic
- Department of Pediatric and Adolescent Surgery, Schneider Children's Medical Center of Israel, Petah-Tiqwa, Israel
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
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9
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Khanal N, Subedi R, Shrestha N, Pradhan SB, Shah P, Shrestha S, Wagle S. Cecal volvulus following appendectomy in a teenage patient: A case report. Clin Case Rep 2024; 12:e8480. [PMID: 38328489 PMCID: PMC10847060 DOI: 10.1002/ccr3.8480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Revised: 01/15/2024] [Accepted: 01/19/2024] [Indexed: 02/09/2024] Open
Abstract
Patients mimicking appendicitis symptoms in a rural setting or those post-appendectomy, indicating cecal volvulus, should always be considered. Swift action can prevent catastrophic consequences. Abstract We present a case of a 14-year-old female who initially underwent open appendectomy for acute appendicitis and subsequently experienced symptoms of abdominal distention, vomiting, and fever. Her condition deteriorated following the appendectomy, despite a prior appendectomy for similar symptoms at a different facility. A computed tomography (CT) scan identified cecal volvulus as the underlying issue. This led to the performance of a laparotomy, cecopexy, and decompressive ileostomy. After six weeks, ileostomy closure was successfully carried out, and the patient currently enjoys good health. This case highlights the significance of considering uncommon factors as potential contributors to postoperative complications in young patients.
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Affiliation(s)
- N. Khanal
- Department of SurgeryHetauda Hospital, Madan Bhandari Academy of Health SciencesHetaudaNepal
| | - R. Subedi
- Department of SurgeryHetauda Hospital, Madan Bhandari Academy of Health SciencesHetaudaNepal
| | - N. Shrestha
- Department of SurgeryHetauda Hospital, Madan Bhandari Academy of Health SciencesHetaudaNepal
| | - S. B. Pradhan
- Department of SurgeryHetauda Hospital, Madan Bhandari Academy of Health SciencesHetaudaNepal
| | - P. Shah
- Department of SurgeryHetauda Hospital, Madan Bhandari Academy of Health SciencesHetaudaNepal
| | - S. Shrestha
- Department of SurgeryHetauda Hospital, Madan Bhandari Academy of Health SciencesHetaudaNepal
| | - S. Wagle
- Department of RadiologyHetauda Hospital, Madan Bhandari Academy of Health SciencesHetaudaNepal
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10
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Zouari M, Issaoui A, Hbaieb M, Belhajmansour M, Meddeb S, Ben Dhaou M, Mhiri R. Predictive Factors of Acute Appendicitis in Children With Non-Visualized Appendix on Ultrasound: A Prospective Cohort Study. Surg Infect (Larchmt) 2024; 25:26-31. [PMID: 38054935 DOI: 10.1089/sur.2023.295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/07/2023] Open
Abstract
Background: Most studies have demonstrated the high accuracy of ultrasound for the diagnosis of acute appendicitis (AA) in children. However, the lack of visualization of the appendix on ultrasound is usually a challenge. The aim of this study was to identify any factors that might help the physician make the right decision when dealing with a child with suspected appendicitis and an appendix not seen on ultrasound. Patients and Methods: After receiving Institutional Review Board approval, we conducted a prospective study in a pediatric emergency department from January 1, 2022, to December 31, 2022. All children under 14 years of age with suspected AA and an appendix not visualized on ultrasound were included. Results: During the study period, 333 children presented with suspected AA. Of these patients, 106 had an appendix not seen on ultrasound. Our patients' median age was 10 years (interquartile range [IQR], 8-11 years), with 54.7% (n = 58) of children being female. Twenty-five (23.6%) were ultimately diagnosed with AA based on pathologic examination. Multivariable logistic regression analysis revealed that Alvarado score ≥6 and increased peri-appendiceal fat echogenicity were predictive for AA. The combination of these two factors provided a positive predictive value of 100%. A white blood cell (WBC) count ≤10 × 109/L and/or a C-reactive protein (CRP) level ≤6 mg/L makes the diagnosis of appendicitis unlikely. Conclusions: In conclusion, our study demonstrated that an Alvarado score at or above six and increased peri-appendiceal fat echogenicity are independent predictive factors of AA in children with non-visualized appendix on ultrasound. The combination of these two factors would confirm the diagnosis of AA in these patients.
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Affiliation(s)
- Mohamed Zouari
- Research Laboratory "Developmental and Induced Diseases" (LR19ES12), Faculty of Medicine of Sfax, University of Sfax, Sfax, Tunisia
- Department of Pediatric Surgery, Hedi Chaker Hospital, Sfax, Tunisia
| | - Asma Issaoui
- Research Laboratory "Developmental and Induced Diseases" (LR19ES12), Faculty of Medicine of Sfax, University of Sfax, Sfax, Tunisia
- Department of Pediatric Surgery, Hedi Chaker Hospital, Sfax, Tunisia
| | - Manar Hbaieb
- Research Laboratory "Developmental and Induced Diseases" (LR19ES12), Faculty of Medicine of Sfax, University of Sfax, Sfax, Tunisia
- Department of Pediatric Surgery, Hedi Chaker Hospital, Sfax, Tunisia
| | - Manel Belhajmansour
- Research Laboratory "Developmental and Induced Diseases" (LR19ES12), Faculty of Medicine of Sfax, University of Sfax, Sfax, Tunisia
- Department of Pediatric Surgery, Hedi Chaker Hospital, Sfax, Tunisia
| | - Souad Meddeb
- Research Laboratory "Developmental and Induced Diseases" (LR19ES12), Faculty of Medicine of Sfax, University of Sfax, Sfax, Tunisia
- Department of Pediatric Surgery, Hedi Chaker Hospital, Sfax, Tunisia
| | - Mahdi Ben Dhaou
- Research Laboratory "Developmental and Induced Diseases" (LR19ES12), Faculty of Medicine of Sfax, University of Sfax, Sfax, Tunisia
- Department of Pediatric Surgery, Hedi Chaker Hospital, Sfax, Tunisia
| | - Riadh Mhiri
- Research Laboratory "Developmental and Induced Diseases" (LR19ES12), Faculty of Medicine of Sfax, University of Sfax, Sfax, Tunisia
- Department of Pediatric Surgery, Hedi Chaker Hospital, Sfax, Tunisia
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11
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Hennenberg J, Zott T, Berger-Kulemann V, Schiefer AI, Kristo I. Diagnosis and Management of the Largest Documented Appendicolith in Literature: A Case Report. Cureus 2024; 16:e54353. [PMID: 38500926 PMCID: PMC10946294 DOI: 10.7759/cureus.54353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/16/2024] [Indexed: 03/20/2024] Open
Abstract
This case report depicts the diagnosis and management of the largest documented appendicolith found in the medical literature so far, measuring 4.5 cm. A 44-year-old male patient presented with a distended abdomen, right lower quadrant (RLQ) pain, constipation, and the inability to consume solid food. Laboratory tests revealed leukocytosis and elevated C-reactive protein (CRP) levels. Abdominal X-rays showed a densely calcified structure in the right lower quadrant, and further imaging confirmed the diagnosis of appendicolithiasis. The surgical indication for appendectomy was determined, and an open surgical procedure was performed due to the severity of inflammation, minimal perforation, and extensive adhesions. The surgically removed appendix with the appendicolith was analyzed histologically, confirming appendicolithiasis, periappendicitis, perforation, and serositis. The patient was discharged in stable condition after postoperative management. Giant appendicoliths are rare and associated with an increased risk of complications. Diagnosis is typically clinical but can be enhanced by imaging modalities.
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Affiliation(s)
| | - Tobias Zott
- General Surgery, Medical University of Vienna, Vienna, AUT
| | | | | | - Ivan Kristo
- General Surgery, Medical University of Vienna, Vienna, AUT
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12
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Yu F, Bu X, Meng N, Xia L. Acute purulent enteritis after appendectomy: report of a case. J Surg Case Rep 2024; 2024:rjae027. [PMID: 38322356 PMCID: PMC10838676 DOI: 10.1093/jscr/rjae027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Accepted: 01/10/2024] [Indexed: 02/08/2024] Open
Abstract
Acute purulent enteritis is uncommon, which occasionally occurs in association with mechanical injuries from foreign bodies of helminth parasites and the contaminated food, leading to bacterial invasion. Herein we report a case of acute purulent enteritis after appendectomy. A 44-year-old male was diagnosed with right lower abdominal pain and vomiting. Acute appendicitis was diagnosed, and an open appendectomy was performed. Postoperatively, the patient developed symptoms of small intestine obstruction. A laparotomy revealed necrosis of the small intestine, and resection was performed. Pathological examination confirmed acute purulent enteritis. Acute purulent enteritis, which is a serious disease resulting in great disaster to patients, following appendectomy is uncommon. Prompt recognition and abdominal computerized tomography scanning are crucial for accurate diagnosis. Early intervention is necessary to prevent complications.
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Affiliation(s)
- Feng Yu
- Department of General Surgery, Affiliated People's Hospital, Jiangsu University, Zhenjiang 212002, Jiangsu Province, China
| | - Xuefeng Bu
- Department of General Surgery, Affiliated People's Hospital, Jiangsu University, Zhenjiang 212002, Jiangsu Province, China
| | - Nana Meng
- Department of Ophthalmology, Affiliated People's Hospital, Jiangsu University, Zhenjiang 212002, Jiangsu Province, China
- Zhenjiang Kangfu Eye Hospital, Zhenjiang 212002, Jiangsu Province, China
| | - Leizhou Xia
- Department of General Surgery, Affiliated People's Hospital, Jiangsu University, Zhenjiang 212002, Jiangsu Province, China
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13
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Adir A, Braester A, Natalia P, Najib D, Akria L, Suriu C, Masad B, Igor W. The role of blood inflammatory markers in the preoperative diagnosis of acute appendicitis. Int J Lab Hematol 2024; 46:58-62. [PMID: 37644670 DOI: 10.1111/ijlh.14163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2023] [Accepted: 07/21/2023] [Indexed: 08/31/2023]
Abstract
INTRODUCTION Acute appendicitis (AA) requires a prompt diagnosis. According to postoperative pathological results, a significant number of appendectomies are performed on a normal appendix (NA). The aim of this study is to evaluate the role of preoperative inflammatory markers in supporting and improving the clinical diagnosis of AA, extracting more information from CBC parameters. METHODS The study is a retrospective one. The histopathological results of operated appendix from 102 patients, who underwent appendectomy for clinically suspected AA, were extracted from the Galilee Medical Center systems. Two patient groups (NA and true AA) were compared for neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR), monocyte to lymphocyte ratio (MLR) and mean platelet volume (MPV). The obtained data were statistically analyzed, using the independent sample t test and Mann-Whitney test. Category data have been compared among groups with the chi-squared test. The primary endpoint of our research was to assess the predictive power of blood biomarkers. RESULTS Patients with suspected AA, based on clinical picture and contrast enhanced computed tomography (CECT), and with MLR-value ≥0.3357 were 5.25 times more likely than normal to have AA. Patients with NLR-value ≥3.2223 were 7 times more likely than normal to have AA. The differences in PLR and MPV values were not statistically significant. CONCLUSIONS The NLR and MLR biomarkers can assist in diagnosis of AA. This can be particularly helpful in cases where CECT is contraindicated, as in pregnant women or children.
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Affiliation(s)
- Alper Adir
- Azrieli Faculty of Medicine, Bar Ilan University, Safed, Israel
| | - Andrei Braester
- Azrieli Faculty of Medicine, Bar Ilan University, Safed, Israel
- Hematology Institute, Galilee Medical Center, Nahariya, Israel
| | | | - Dally Najib
- Hematology Institute, Galilee Medical Center, Nahariya, Israel
- Hematology Institute, Ziv Medical Center, Safed, Israel
| | - Luiza Akria
- Azrieli Faculty of Medicine, Bar Ilan University, Safed, Israel
- Hematology Institute, Galilee Medical Center, Nahariya, Israel
| | - Celia Suriu
- Azrieli Faculty of Medicine, Bar Ilan University, Safed, Israel
- Hematology Institute, Galilee Medical Center, Nahariya, Israel
| | - Barhoum Masad
- Azrieli Faculty of Medicine, Bar Ilan University, Safed, Israel
- Hematology Institute, Galilee Medical Center, Nahariya, Israel
| | - Waksman Igor
- Azrieli Faculty of Medicine, Bar Ilan University, Safed, Israel
- Hematology Institute, Galilee Medical Center, Nahariya, Israel
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14
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Carvalho N, Carolino E, Ferreira M, Coelho H, Santos CR, Barreira AL, Henriques S, Cardoso C, Moita L, Costa PM. Tryptase in Acute Appendicitis: Unveiling Allergic Connections through Compelling Evidence. Int J Mol Sci 2024; 25:1645. [PMID: 38338923 PMCID: PMC10855922 DOI: 10.3390/ijms25031645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Revised: 01/23/2024] [Accepted: 01/24/2024] [Indexed: 02/12/2024] Open
Abstract
The aetiology of acute appendicitis (AA), the most frequent abdominal surgical emergency, is still unclarified. Recent epidemiologic, clinical and laboratorial data point to an allergic component in the pathophysiology of AA. Mastocytes participate in the Th2 immune response, releasing inflammatory mediators from their granules upon stimulation by IgE-specific antigens. Among the well-known mediators are histamine, serotonin and tryptase, which are responsible for the clinical manifestations of allergies. We conducted a prospective single-centre study to measure histamine and serotonin (commercial ELISA kit) and tryptase (ImmunoCAP System) concentrations in appendicular lavage fluid (ALF) and serum. Consecutive patients presenting to the emergency department with a clinical diagnosis of AA were enrolled: 22 patients with phlegmonous AA and 24 with gangrenous AA The control group was composed of 14 patients referred for colectomy for colon malignancy. Appendectomy was performed during colectomy. Tryptase levels were strikingly different between histological groups, both in ALF and serum (p < 0.001); ALF levels were higher than serum levels. Tryptase concentrations in ALF were 109 times higher in phlegmonous AA (APA) (796.8 (194.1-980.5) pg/mL) and 114 times higher in gangrenous AA (AGA) (837.4 (272.6-1075.1) pg/mL) than in the control group (7.3 (4.5-10.3) pg/mL. For the diagnosis of AA, the discriminative power of serum tryptase concentration was good (AUC = 0.825), but discriminative power was weak (AUC = 0.559) for the differential diagnosis between APA and AGA. Mastocytes are involved in AA during clinical presentations of both phlegmonous and gangrenous appendicitis, and no significant differences in concentration were found. No differences were found in serum and ALF concentrations of histamine and serotonin between histological groups. Due to their short half-lives, these might have elapsed by the time the samples were collected. In future research, these determinations should be made immediately after appendectomy. Our findings confirm the hypersensitivity type I reaction as an event occurring in the pathogenesis of AA: tryptase levels in ALF and serum were higher among patients with AA when compared to the control group, which is in line with a Th2 immune response and supports the concept of the presence of an allergic reaction in the pathogenesis of acute appendicitis. Our results, if confirmed, may have clinical implications for the treatment of AA.
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Affiliation(s)
- Nuno Carvalho
- Serviço Cirurgia Geral, Hospital Garcia de Orta, 2805-267 Almada, Portugal; (M.F.); (A.L.B.); (S.H.); (P.M.C.)
- Faculdade Medicina, Universidade Lisboa, 1649-028 Lisboa, Portugal
| | - Elisabete Carolino
- H & TRC—Health & Technology Research Centre, ESTeSL—Escola Superior de Tecnologia da Saúde, Instituto Politécnico de Lisboa, 1549-020 Lisboa, Portugal;
| | - Margarida Ferreira
- Serviço Cirurgia Geral, Hospital Garcia de Orta, 2805-267 Almada, Portugal; (M.F.); (A.L.B.); (S.H.); (P.M.C.)
- Faculdade Medicina, Universidade Lisboa, 1649-028 Lisboa, Portugal
| | - Hélder Coelho
- Serviço de Anatomia Patológica, Hospital Garcia de Orta, 2805-267 Almada, Portugal;
| | - Catarina Rolo Santos
- Serviço de Cirurgia Geral, Hospital de Nossa Senhora do Rosário, 2830-003 Barreiro, Portugal;
| | - Ana Lúcia Barreira
- Serviço Cirurgia Geral, Hospital Garcia de Orta, 2805-267 Almada, Portugal; (M.F.); (A.L.B.); (S.H.); (P.M.C.)
| | - Susana Henriques
- Serviço Cirurgia Geral, Hospital Garcia de Orta, 2805-267 Almada, Portugal; (M.F.); (A.L.B.); (S.H.); (P.M.C.)
| | - Carlos Cardoso
- Dr. Joaquim Chaves Laboratório de Análises Clínicas, 1495-068 Algés, Portugal;
| | - Luís Moita
- Innate Immunity and Inflammation Lab., Instituto Gulbenkian de Ciência Oeiras, 2780-156 Oeiras, Portugal;
- Instituto de Histologia e Biologia do Desenvolvimento, Faculdade Medicina, Universidade Lisboa, 1649-028 Lisboa, Portugal
| | - Paulo Matos Costa
- Serviço Cirurgia Geral, Hospital Garcia de Orta, 2805-267 Almada, Portugal; (M.F.); (A.L.B.); (S.H.); (P.M.C.)
- Faculdade Medicina, Universidade Lisboa, 1649-028 Lisboa, Portugal
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15
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Demyashkin G, Gorokhov K, Shchekin V, Vadyukhin M, Matevosyan A, Rudavina A, Pilipchuk A, Pilipchuk A, Kochetkova S, Atiakshin D, Shegay P, Kaprin A. Features of Appendix and the Characteristics of Appendicitis Development in Children with COVID-19. Biomedicines 2024; 12:312. [PMID: 38397914 PMCID: PMC10886907 DOI: 10.3390/biomedicines12020312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Revised: 01/22/2024] [Accepted: 01/25/2024] [Indexed: 02/25/2024] Open
Abstract
BACKGROUND Research on the subject of the influence of SARS-CoV-2 mechanisms on human homeostasis remains an actual problem. Particular interest is the study of pathomorphological changes in the appendix in children with COVID-19. OBJECTIVES Aim of this study: morphological and molecular biological evaluation of the appendix in children of different age groups with COVID-19. METHODS Groups were formed on the basis of anamnestic, clinical, and morphological data: I (n = 42; aged 2 to 18 years, average age-10.8 ± 4.79)-with an established clinical diagnosis: coronavirus infection (COVID-19; PCR+); II (n = 55; aged 2 to 18 years, average age-9.7 ± 4.77)-with a confirmed clinical diagnosis of acute appendicitis; collected before the onset of the COVID-19 pandemic in 2017-2019; and III (n = 38; aged 2 to 18 years, average age-10.3 ± 4.62)-the control group. Histological and immunohistochemical studies were conducted using primary antibodies to CD3, CD4, CD68, CD163, CD20, and CD138 and to pro-inflammatory (IL-1, IL-6) and anti-inflammatory (IL-4, IL-10) cytokines. RESULTS In most samples of appendixes in children with COVID-19, signs of destructive phlegmonous-ulcerative and gangrenous appendicitis were discovered. An increase in CD3+, CD4+, CD68+, CD163+, and CD20+ CD138+ immunocompetent cells was found in the appendix of children with COVID-19. As well, there was an increase in pro-inflammatory (IL-1, IL-6) and anti-inflammatory (IL-4, IL-10) cytokines. CONCLUSIONS The aforementioned pathological and immunohistochemical changes were more pronounced in the group of children aged 6-12 years (childhood).
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Affiliation(s)
- Grigory Demyashkin
- Department of Pathomorphology, National Medical Research Centre of Radiology, Ministry of Health of Russia, 249036 Obninsk, Russia; (K.G.); (P.S.); (A.K.)
- Laboratory of Histology and Immunohistochemistry, I.M. Sechenov First Moscow State Medical University (Sechenov University), 119048 Moscow, Russia; (G.D.); (M.V.); (A.M.); (A.R.); (A.P.); (A.P.); (S.K.)
| | - Konstantin Gorokhov
- Department of Pathomorphology, National Medical Research Centre of Radiology, Ministry of Health of Russia, 249036 Obninsk, Russia; (K.G.); (P.S.); (A.K.)
| | - Vladimir Shchekin
- Laboratory of Histology and Immunohistochemistry, I.M. Sechenov First Moscow State Medical University (Sechenov University), 119048 Moscow, Russia; (G.D.); (M.V.); (A.M.); (A.R.); (A.P.); (A.P.); (S.K.)
| | - Matvey Vadyukhin
- Laboratory of Histology and Immunohistochemistry, I.M. Sechenov First Moscow State Medical University (Sechenov University), 119048 Moscow, Russia; (G.D.); (M.V.); (A.M.); (A.R.); (A.P.); (A.P.); (S.K.)
| | - Artem Matevosyan
- Laboratory of Histology and Immunohistochemistry, I.M. Sechenov First Moscow State Medical University (Sechenov University), 119048 Moscow, Russia; (G.D.); (M.V.); (A.M.); (A.R.); (A.P.); (A.P.); (S.K.)
| | - Arina Rudavina
- Laboratory of Histology and Immunohistochemistry, I.M. Sechenov First Moscow State Medical University (Sechenov University), 119048 Moscow, Russia; (G.D.); (M.V.); (A.M.); (A.R.); (A.P.); (A.P.); (S.K.)
| | - Anna Pilipchuk
- Laboratory of Histology and Immunohistochemistry, I.M. Sechenov First Moscow State Medical University (Sechenov University), 119048 Moscow, Russia; (G.D.); (M.V.); (A.M.); (A.R.); (A.P.); (A.P.); (S.K.)
| | - Alina Pilipchuk
- Laboratory of Histology and Immunohistochemistry, I.M. Sechenov First Moscow State Medical University (Sechenov University), 119048 Moscow, Russia; (G.D.); (M.V.); (A.M.); (A.R.); (A.P.); (A.P.); (S.K.)
| | - Svetlana Kochetkova
- Laboratory of Histology and Immunohistochemistry, I.M. Sechenov First Moscow State Medical University (Sechenov University), 119048 Moscow, Russia; (G.D.); (M.V.); (A.M.); (A.R.); (A.P.); (A.P.); (S.K.)
| | - Dmitrii Atiakshin
- Research and Educational Resource Center for Immunophenotyping, Digital Spatial Profiling and Ultrastructural Analysis Innovative Technologies, Peoples’ Friendship University of Russia (RUDN University), 117198 Moscow, Russia;
| | - Petr Shegay
- Department of Pathomorphology, National Medical Research Centre of Radiology, Ministry of Health of Russia, 249036 Obninsk, Russia; (K.G.); (P.S.); (A.K.)
| | - Andrey Kaprin
- Department of Pathomorphology, National Medical Research Centre of Radiology, Ministry of Health of Russia, 249036 Obninsk, Russia; (K.G.); (P.S.); (A.K.)
- Research and Educational Resource Center for Immunophenotyping, Digital Spatial Profiling and Ultrastructural Analysis Innovative Technologies, Peoples’ Friendship University of Russia (RUDN University), 117198 Moscow, Russia;
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16
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Haddad F, Afifi M, El Rhaoussi FZ, Tahiri M, Hliwa W, Bellabah A, Hachimi S, Bennani Guebessi N, Wafaa B. A Rare Case of Tuberculosis Revealed by Acute Appendicitis: A Case Report. Cureus 2024; 16:e51733. [PMID: 38318599 PMCID: PMC10839630 DOI: 10.7759/cureus.51733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/05/2024] [Indexed: 02/07/2024] Open
Abstract
According to the World Health Organization (WHO), tuberculosis (TB) is the 13th cause of death worldwide and the second infectious killer after HIV. It is an endemic disease in Morocco. Isolated appendicular TB is an uncommon form of extrapulmonary TB. We report a case of a 26-year-old woman admitted for acute abdominal pain in the right iliac fossa with fever, vomiting, and diarrhea. Physical examination and abdominal ultrasound confirmed appendicitis. Surgery was performed and revealed on histopathological examination of the resected appendix the diagnosis of tubercular appendicitis. The patient was initiated on the conventional antitubercular regimen for six months and would be followed up appropriately. This case report highlights the importance of histopathological examination of appendicectomy specimens in order to diagnose rare diseases such as primary TB of the appendix.
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Affiliation(s)
- Fouad Haddad
- Gastroenterology and Hepatology, Ibn Rochd University Hospital Center, Casablanca, MAR
| | - Malak Afifi
- Gastroenterology and Hepatology, Ibn Rochd University Hospital Center, Casablanca, MAR
| | - Fatima Zahra El Rhaoussi
- Medicine and Pharmacy, Hassan II University, Casablanca, MAR
- Gastroenterology and Hepatology, Ibn Rochd University Hospital Center, Casablanca, MAR
| | - Mohamed Tahiri
- Gastroenterology and Hepatology, Ibn Rochd University Hospital Center, Casablanca, MAR
| | - Wafaa Hliwa
- Gastroenterology and Hepatology, Ibn Rochd University Hospital Center, Casablanca, MAR
| | - Ahmed Bellabah
- Gastroenterology and Hepatology, Ibn Rochd University Hospital Center, Casablanca, MAR
| | - Sanaa Hachimi
- Anatomical Pathology, Ibn Rochd University Hospital Center, Casablanca, MAR
| | | | - Badre Wafaa
- Gastroenterology and Hepatology, Ibn Rochd University Hospital Center, Casablanca, MAR
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17
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Mithany RH, Shaikh A, Scott C, Abdalla M, Graham M, Gerogiannis IN. Can Salmonella typhi Cause Acute Appendicitis? Cureus 2024; 16:e53213. [PMID: 38425622 PMCID: PMC10902744 DOI: 10.7759/cureus.53213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/30/2024] [Indexed: 03/02/2024] Open
Abstract
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.
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Affiliation(s)
- Reda H Mithany
- Laparoscopic Colorectal Surgery, Kingston Hospital NHS Foundation Trust, Kingston Upon Thames, GBR
| | - Amarah Shaikh
- General Surgery, Kingston Hospital NHS Foundation Trust, Kingston Upon Thames, GBR
| | - Catherine Scott
- General Surgery, Kingston Hospital NHS Foundation Trust, Kingston Upon Thames, GBR
| | - Mazin Abdalla
- General Surgery, Kingston Hospital NHS Foundation Trust, Kingston Upon Thames, GBR
| | - Matthew Graham
- General Surgery, Kingston Hospital NHS Foundation Trust, Kingston Upon Thames, GBR
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18
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Chin X, Mallika Arachchige S, Orbell-Smith JL, Da Rocha D, Gandhi A. Conservative Versus Surgical Management of Acute Appendicitis: A Systematic Review. Cureus 2024; 16:e52697. [PMID: 38384640 PMCID: PMC10879736 DOI: 10.7759/cureus.52697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/21/2024] [Indexed: 02/23/2024] Open
Abstract
Recent studies have discussed the role of antibiotic treatment in the conservative management of acute appendicitis and whether antibiotics are a safe option to replace appendicectomy, which has been the gold standard treatment of acute appendicitis for many years. The bibliographic databases Cumulative Index to Nursing and Allied Health Literature (CINAHL), Cochrane, Embase, Medline, and PubMed comparing conservative versus surgical treatment of acute appendicitis were systematically searched according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Twenty-one studies consisting of systematic reviews and meta-analyses involving 44,699 participants were identified. At least 17,865 participants were treated with antibiotics. Our studies compare antibiotic versus appendicectomy among acute appendicitis patients ranging from 7 to 94 years of age. In most studies, patients received parenteral antibiotics for a total of one to three days, and oral antibiotics such as oral cephalosporin plus metronidazole, oral amoxicillin/clavulanate, oral fluoroquinolones plus Tinidazole upon hospital discharge for a total of 7 to 10 days. The total course of antibiotics for both parenteral and oral regimes ranged from 2 to 16 days, with 10 days being the commonest duration. The recurrence rate following initial antibiotic treatment at one-year follow-up ranged from 13% to 38%, while the mean duration of recurrence ranged from three to eight months. The majority of the patients with recurrence underwent appendicectomy, while some patients were either given a repeat or different course of antibiotics due to the possible presence of antibiotic resistance; however, only 2.4% of the patients were successfully treated upon completion of the second course of antibiotics. Most of the studies concluded that appendicectomy remains the gold standard treatment for uncomplicated acute appendicitis, given its higher efficacy and lower complication rates. Although antibiotic treatment cannot be routinely recommended, it can be considered an appropriate alternative in selected patients with uncomplicated appendicitis who wish to avoid surgery and also acknowledge the risk of recurrence and the potential need for subsequent surgery at the same time.
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Affiliation(s)
- Xinlin Chin
- General Surgery, Mackay Base Hospital, Mackay, AUS
- Medicine, James Cook University, Mackay, AUS
- Medicine and Dentistry, Griffith University, Birtinya, AUS
| | | | | | | | - Anil Gandhi
- General Surgery, Monash University, Faculty of Medicine, Nursing and Health Sciences, Selangor, MYS
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19
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Al Bazroon AA, Alabandi AM, Alnemer MM, Abu Alsaud S. Scrotal Pyocele Secondary to Perforated Appendicitis in Middle-Aged Man: A Case Report and Review of Literature. Cureus 2024; 16:e51476. [PMID: 38298279 PMCID: PMC10830134 DOI: 10.7759/cureus.51476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/13/2023] [Indexed: 02/02/2024] Open
Abstract
A scrotal abscess following perforated appendicitis is a rare complication. This is mostly seen in children and usually occurs due to the presence of the patent processus vaginalis, which permits the passage of pus from the intra-abdominal cavity down to the scrotum, resulting in a scrotal pyocele. There are few reported cases of such complications in young adult patients. We report a case of a 50-year-old male with a scrotal pyocele following exploratory laparotomy for perforated appendicitis. Scrotal ultrasound (US) findings were suggestive of a right-sided scrotal abscess, and the CT scan showed prominent fat in the proximal part of the right inguinal canal, which suggested the presence of a partially patent processus vaginalis. Our case is the first reported in the middle-aged group, and our review of the literature is the first directed to the adult age group. This review emphasizes the importance of considering scrotal pyocele in any patient with acute scrotum post-appendectomy, regardless of the patient's age, the affected side, and the presence or absence of identifiable patent processus vaginalis, as it may be microscopically permeable. Treatment will entail urgent drainage of the abscess, together with a course of antibiotics.
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Affiliation(s)
| | - Ali M Alabandi
- Department of Urology, Dammam Medical Complex, Dammam, SAU
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20
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Liao Y, Ma Y, Chao F, Wang Y, Zhao Z, Ren J. A 37-Year-Old Schizophrenic Woman With Abdominal Pain. Clin Med Insights Case Rep 2023; 16:11795476231219076. [PMID: 38106620 PMCID: PMC10725092 DOI: 10.1177/11795476231219076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Accepted: 11/21/2023] [Indexed: 12/19/2023]
Abstract
Introduction Internal fistula across the posterior wall of stomach and the transverse colon caused by foreign bodies in the alimentary tract presents an extremely rare medical entity. Presentation of case We report an aschizophrenia female patient with onset of internal fistula across the posterior wall of stomach and the transverse colon triggered by swallowed magnetic metal beads. The patient was admitted to the emergency room of Northern Jiangsu People's Hospital because of acute right lower abdominal pain. Emergency routine abdominal CT scan revealed acute appendicitis and a set of foreign body in digestive tract. Discussion The foreign body in the stomach was removed by open surgery after tentative Endoscopic foreign body removal and laparoscopic appendectomy and exploration. In the process of exploring the gastric wall, it was found that one of magnet beads was embedded in the posterior wall of stomach and adhered to part of the transverse colon. After separation, it was found that an internal fistula was formed across the posterior wall of stomach and the transverse colon. As the patient ate only a small amount of food within 2 days, and the intestines were in good condition, we performed partial transverse colectomy, end-to-side anastomosis and gastric wall repair. Conclusion This case shows that for long-term foreign bodies in the digestive tract, we should be beware of the onset of gastrointestinal perforation. Moreover, perforation caused by the force acting on a blunt foreign body often results in atypical imaging findings, and the diagnosis of perforation cannot be clearly determined by imaging findings such as the presence of free gas downstream of the diaphragm. This poses new challenges for clear diagnosis and treatment.
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Affiliation(s)
- Yiqun Liao
- Department of Clinical Medical college, The Yangzhou School of Clinical Medicine, Dalian Medical University, Dalian, China
| | - Yue Ma
- General Surgery Institute of Yangzhou, Yangzhou University, Yangzhou, China
- Northern Jiangsu People’s Hospital Affiliated to Medical School of Nanjing University, Yangzhou, China
| | - Fei Chao
- Department of Anesthesiology, Northern Jiangsu People’s Hospital Affiliated to Yangzhou University, Yangzhou, China
| | - Yong Wang
- General Surgery Institute of Yangzhou, Yangzhou University, Yangzhou, China
- Northern Jiangsu People’s Hospital Affiliated to Yangzhou University, Yangzhou, China
- Yangzhou Key Laboratory of Basic and Clinical Transformation of Digestive and Metabolic Diseases, Yangzhou, China
| | - Ziming Zhao
- General Surgery Institute of Yangzhou, Yangzhou University, Yangzhou, China
- Northern Jiangsu People’s Hospital Affiliated to Yangzhou University, Yangzhou, China
| | - Jun Ren
- General Surgery Institute of Yangzhou, Yangzhou University, Yangzhou, China
- Northern Jiangsu People’s Hospital Affiliated to Yangzhou University, Yangzhou, China
- Yangzhou Key Laboratory of Basic and Clinical Transformation of Digestive and Metabolic Diseases, Yangzhou, China
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21
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Markovic N, Stojanovic B, Jovanovic I, Milosevic B, Spasic M, Radosavljevic I, Zdravkovic N, Radovanovic D, Stojanovic BS, Spasojevic M, Jovanovic M, Todorovic Z, Pavlovic M, Sretenovic S, Milosavljevic MZ, Dimitrijevic Stojanovic M. Metastatic Breast Cancer Presenting as Acute Appendicitis: A Rare Case Study and Review of Current Knowledge. Diagnostics (Basel) 2023; 13:3657. [PMID: 38132241 PMCID: PMC10743293 DOI: 10.3390/diagnostics13243657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2023] [Revised: 12/05/2023] [Accepted: 12/07/2023] [Indexed: 12/23/2023] Open
Abstract
This manuscript discusses a rare case of acute appendicitis caused by metastasis from invasive breast carcinoma of no special type in a 70-year-old female previously diagnosed with breast cancer. It delves into the diagnostic challenges and management complexities of such unusual clinical presentations. The paper includes an analysis of 19 documented cases, enriching the understanding of metastatic patterns and treatment strategies in breast cancer. It underlines the importance of considering a history of malignancy when diagnosing acute abdominal conditions and emphasizes a comprehensive approach in interpreting diagnostic imaging in patients with past oncological issues to effectively manage metastatic breast cancer exhibiting atypical manifestations.
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Affiliation(s)
- Nenad Markovic
- Department of Surgery, Faculty of Medical Sciences, University of Kragujevac, 34000 Kragujevac, Serbia; (N.M.); (B.S.); (B.M.); (M.S.); (D.R.); (M.P.)
| | - Bojan Stojanovic
- Department of Surgery, Faculty of Medical Sciences, University of Kragujevac, 34000 Kragujevac, Serbia; (N.M.); (B.S.); (B.M.); (M.S.); (D.R.); (M.P.)
| | - Ivan Jovanovic
- Center for Molecular Medicine and Stem Cell Research, Faculty of Medical Sciences, University of Kragujevac, 34000 Kragujevac, Serbia;
| | - Bojan Milosevic
- Department of Surgery, Faculty of Medical Sciences, University of Kragujevac, 34000 Kragujevac, Serbia; (N.M.); (B.S.); (B.M.); (M.S.); (D.R.); (M.P.)
| | - Marko Spasic
- Department of Surgery, Faculty of Medical Sciences, University of Kragujevac, 34000 Kragujevac, Serbia; (N.M.); (B.S.); (B.M.); (M.S.); (D.R.); (M.P.)
| | - Ivan Radosavljevic
- Department of Surgery, Faculty of Medical Sciences, University of Kragujevac, 34000 Kragujevac, Serbia; (N.M.); (B.S.); (B.M.); (M.S.); (D.R.); (M.P.)
| | - Natasa Zdravkovic
- Department of Internal Medicine, Faculty of Medical Sciences, University of Kragujevac, 34000 Kragujevac, Serbia; (N.Z.); (M.J.); (S.S.)
| | - Dragce Radovanovic
- Department of Surgery, Faculty of Medical Sciences, University of Kragujevac, 34000 Kragujevac, Serbia; (N.M.); (B.S.); (B.M.); (M.S.); (D.R.); (M.P.)
| | - Bojana S. Stojanovic
- Department of Pathophysiology, Faculty of Medical Sciences, University of Kragujevac, 34000 Kragujevac, Serbia;
| | - Marija Spasojevic
- Department of Pathology, Faculty of Medical Sciences, University of Kragujevac, 34000 Kragujevac, Serbia; (M.S.); (M.Z.M.); (M.D.S.)
| | - Marina Jovanovic
- Department of Internal Medicine, Faculty of Medical Sciences, University of Kragujevac, 34000 Kragujevac, Serbia; (N.Z.); (M.J.); (S.S.)
| | - Zeljko Todorovic
- Department of Internal Medicine, Faculty of Medical Sciences, University of Kragujevac, 34000 Kragujevac, Serbia; (N.Z.); (M.J.); (S.S.)
| | - Mladen Pavlovic
- Department of Surgery, Faculty of Medical Sciences, University of Kragujevac, 34000 Kragujevac, Serbia; (N.M.); (B.S.); (B.M.); (M.S.); (D.R.); (M.P.)
| | - Snezana Sretenovic
- Department of Internal Medicine, Faculty of Medical Sciences, University of Kragujevac, 34000 Kragujevac, Serbia; (N.Z.); (M.J.); (S.S.)
| | - Milos Z. Milosavljevic
- Department of Pathology, Faculty of Medical Sciences, University of Kragujevac, 34000 Kragujevac, Serbia; (M.S.); (M.Z.M.); (M.D.S.)
| | - Milica Dimitrijevic Stojanovic
- Department of Pathology, Faculty of Medical Sciences, University of Kragujevac, 34000 Kragujevac, Serbia; (M.S.); (M.Z.M.); (M.D.S.)
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Pogorelić Z, Ercegović V, Bašković M, Jukić M, Karaman I, Mrklić I. Incidence and Management of Appendiceal Neuroendocrine Tumors in Pediatric Population: A Bicentric Experience with 6285 Appendectomies. Children (Basel) 2023; 10:1899. [PMID: 38136101 PMCID: PMC10741616 DOI: 10.3390/children10121899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Revised: 12/03/2023] [Accepted: 12/05/2023] [Indexed: 12/24/2023]
Abstract
BACKGROUND Neuroendocrine tumors (NETs) are rare tumors that arise from neuroendocrine cells and are the most common tumors of the appendix. NETs of the appendix usually cause no symptoms and often go unnoticed until they cause acute appendicitis or are discovered during an accidental appendectomy. As the trend towards the conservative treatment of acute appendicitis increases in the pediatric population, the question arises as to whether the majority of NETs go undetected and are only discovered at an advanced stage. The purpose of the proposed study is to review the incidence and outcomes of treatment for NETs of the appendix in children and include the data presented in the data pool for further review. METHODS From 1 January 2009 to 1 November 2023, a total of 6285 appendectomies were performed in two large pediatric centers in Croatia. After a retrospective review of the case records and histopathologic findings, a total of 31 children (0.49%) were diagnosed with NET of the appendix and included in the further analysis. The primary outcome of this study was the incidence and treatment outcome of pediatric patients diagnosed with NET of the appendix. Secondary outcomes included the patients' demographic, clinical, and laboratory data and the histopathologic characteristics of tumor species. RESULTS The overall incidence of NETs of the appendix was stable over the study years, with minor fluctuations. The median age of patients was 14 (interquartile range-IQR: 12, 16) years, with a female predominance (64.5%). The majority of patients (96.8%) presented with acute abdominal pain and underwent appendectomy because acute appendicitis was suspected. Acute appendicitis was confirmed by histopathology in 18 (58%) cases. NETs of the appendix were not detected preoperatively in any of the patients. Among patients with confirmed acute appendicitis, most (n = 14; 77.8%) were found to have non-perforated acute appendicitis. In most children, the tumor was located at the tip of the appendix (n = 18; 58.1%), and the majority of tumors had a diameter of less than 1 cm (n = 21, 67.7%). The mitotic count (n = 25, 80.6%) and Ki-67 proliferation index (n = 23, 74.2%) were low in most patients, so most tumors were classified as NET G1 (n = 25, 80.6%), while NET G2 and NET G3 were found in four (12.9%) and two (6.5%) patients, respectively. All children were treated with appendectomy only. The median follow-up time was 54 (IQR: 24, 95) months. CONCLUSIONS The incidence of appendiceal NET among pediatric patients is very low. NET occurs most frequently in adolescents, with a female predominance. Most tumors are less than 1 cm in diameter, located at the tip, and associated with non-perforated appendicitis. Appendectomy is the treatment of choice, and major surgery was not necessary in our cohort.
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Affiliation(s)
- Zenon Pogorelić
- Department of Pediatric Surgery, University Hospital of Split, 21 000 Split, Croatia;
- Department of Surgery, School of Medicine, University of Split, 21 000 Split, Croatia;
| | - Vladimir Ercegović
- Department of Surgery, School of Medicine, University of Split, 21 000 Split, Croatia;
| | - Marko Bašković
- Department of Pediatric Surgery, Children’s Hospital Zagreb, 10 000 Zagreb, Croatia;
- Scientific Centre of Excellence for Reproductive and Regenerative Medicine, School of Medicine, University of Zagreb, Šalata 3, 10 000 Zagreb, Croatia
| | - Miro Jukić
- Department of Pediatric Surgery, University Hospital of Split, 21 000 Split, Croatia;
- Department of Surgery, School of Medicine, University of Split, 21 000 Split, Croatia;
| | - Ivana Karaman
- Department of Pathology, Forensic Medicine and Cytology, University Hospital of Split, 21 000 Split, Croatia; (I.K.); (I.M.)
| | - Ivana Mrklić
- Department of Pathology, Forensic Medicine and Cytology, University Hospital of Split, 21 000 Split, Croatia; (I.K.); (I.M.)
- Department of Pathology, University of Split School of Medicine, 21 000 Split, Croatia
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23
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Salminen R, Rautio T, Nordström P, Rantanen T, Mällinen J, Grönroos J, Salminen P. Five-year follow-up of appendiceal neoplasm risk in periappendicular abscess in the Peri-Appendicitis Acuta Randomized Clinical Trial. Scand J Surg 2023; 112:265-268. [PMID: 37655682 DOI: 10.1177/14574969231192128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
Affiliation(s)
- Roosa Salminen
- Department of Surgery, University of Oulu, Oulu, Finland
| | - Tero Rautio
- Department of Surgery, University of Oulu, Oulu, Finland
- Division of Operative Care, Oulu University Hospital and Medical Research Center Oulu, University of Oulu, Oulu, Finland
| | - Pia Nordström
- Divison of Surgery, Gastroenterology and Oncology, Tampere University Hospital, Tampere, Finland
| | - Tuomo Rantanen
- Department of Surgery, Kuopio University Hospital, Kuopio, Finland
- Division of Digestive Surgery and Urology, Turku University Hospital, Turku, Finland
| | - Jari Mällinen
- Department of Surgery, University of Oulu, Oulu, Finland
- Division of Operative Care, Oulu University Hospital and Medical Research Center Oulu, University of Oulu, Oulu, Finland
| | - Juha Grönroos
- Division of Digestive Surgery and Urology, Turku University Hospital, Turku, Finland
- Department of Surgery, University of Turku, Turku, Finland
| | - Paulina Salminen
- Paulina Salminen Division of Digestive Surgery and Urology Turku University Hospital P.O. Box 52 Turku 20520 Finland
- Department of Surgery University of Turku Turku Finland
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Wang Y, Ma L, Lu X, Yan X. Effect of endoscopic retrograde appendicitis therapy on surgical site wound infection and hospital stay in patients with acute appendicitis: A meta-analysis. Int Wound J 2023; 20:4281-4290. [PMID: 37500538 PMCID: PMC10681414 DOI: 10.1111/iwj.14330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 07/12/2023] [Accepted: 07/14/2023] [Indexed: 07/29/2023] Open
Abstract
In this meta-analysis, we comprehensively evaluated the effect of endoscopic retrograde appendicitis therapy (ERAT) on surgical site infections and other perioperative outcomes in patients with acute appendicitis. Relevant studies on ERAT for acute appendicitis were retrieved from PubMed, EMBASE, Web of Science, China National Knowledge Infrastructure, and Wanfang Data, from database inception to June 2023. Statistical analyses were performed using RevMan 5.4. Heterogeneity among the included studies was analysed, and odds ratios (ORs) or standardised mean differences (SMDs), along with their respective 95% confidence intervals (CIs), were calculated. In total, 24 studies involving 1937 patients were included in the meta-analysis. ERAT reduced the surgical duration (SMD: -1.70, 95% CI: -2.24 to -1.16, p < 0.001) and length of hospital stay (SMD: -2.09, 95% CI: -2.64 to -1.53, p < 0.001) significantly more than open appendectomy (OA) did. Furthermore, ERAT decreased the incidence of surgical site wound infections (OR: 0.22, 95% CI: 0.13-0.37, p < 0.001) and postoperative complications (OR: 0.16, 95% CI: 0.11-0.21, p < 0.001) more than OA did. This study demonstrated that ERAT is a safe and effective endoscopic treatment modality for acute appendicitis, contributing to a significant reduction in the surgical duration, length of hospital stay, and incidence of surgical site wound infections and postoperative complications. Hence, ERAT has clinical significance and the potential for further application and dissemination.
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Affiliation(s)
- Yin Wang
- Department of GastroenterologyThe People's Hospital of BozhouBozhouChina
| | - Lan Ma
- Department of Infectious DiseaseThe People's Hospital of BozhouBozhouChina
| | - Xingjun Lu
- Department of GastroenterologyThe People's Hospital of BozhouBozhouChina
| | - Xiuxia Yan
- Department of Intensive Care UnitThe People's Hospital of BozhouBozhouChina
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25
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Turhan N, Duran C, Kuzan TY, Kuzan BN, Zarbaliyev E. Risk of Conversion from Laparoscopic Appendectomy to Open Surgery: The Role of Clinical and Radiological Factors in Prediction. J Laparoendosc Adv Surg Tech A 2023; 33:1176-1183. [PMID: 37768845 DOI: 10.1089/lap.2023.0293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/30/2023] Open
Abstract
Introduction: Laparoscopic appendectomy is the most preferred surgical method in the treatment of acute appendicitis. In our study, we aim to determine the clinical and radiological factors affecting conversion from laparoscopic appendectomy to open surgery. Materials and Methods: All patients older than 18 years, who were operated on with the diagnosis of acute appendicitis in the General Surgery clinic of Prof. Dr. İlhan Varank Training and Research hospital between January 2020 and January 2022, were included in the study. The data consisting of clinical, laboratory, and radiological (computed tomography) findings of the patients were evaluated retrospectively. The patients were divided into two groups as those whose surgery was completed laparoscopically (Group 1) and those converted from laparoscopic appendectomy to open surgery (Group 2). The risk of conversion to open surgery was analyzed by binary logistic regression analysis as univariate and multivariate models. Results: Appendectomy was performed in 831 patients within the specified period. The surgery of 31 (3.73%) patients started laparoscopically; however, they were completed by converting to open surgery. Multivariable analysis showed that the risk of conversion to open surgery increased with leukocyte count, Alvarado score and with the presence of periappendiceal fluid and lymphadenopathy on CT. Conclusion: Our study shows that patients with high risk of returning to open surgery can be identified preoperatively with the risk analysis method in which clinical, laboratory, and radiological findings are evaluated together. We conclude that, starting the operation of these patients with the open technique from the beginning will prevent unnecessary expenditures and reduce morbidities.
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Affiliation(s)
- Nihan Turhan
- Department of General Surgery and Sancaktepe Şehit Prof. Dr. İlhan Varank Training and Research Hospital, İstanbul, Türkiye
| | - Cengiz Duran
- Department of General Surgery and Sancaktepe Şehit Prof. Dr. İlhan Varank Training and Research Hospital, İstanbul, Türkiye
| | - Taha Yusuf Kuzan
- Department of Radiology, Sancaktepe Şehit Prof. Dr. İlhan Varank Training and Research Hospital, İstanbul, Türkiye
| | - Beyza Nur Kuzan
- Department of Radiology, Kartal Dr. Lütfi Kırdar City Hospital, İstanbul, Türkiye
| | - Elbrus Zarbaliyev
- Department of General Surgery, Faculty of Medicine, Gaziosmanpaşa Hospital, Istanbul Yeni Yüzyıl University, İstanbul, Türkiye
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Alsaud JS, Alnumayr H, Aljamaan S, Aloufi M, Momtaz A. Acute Appendicitis in a Double Appendix: A Case Report. Cureus 2023; 15:e49799. [PMID: 38161542 PMCID: PMC10757831 DOI: 10.7759/cureus.49799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/01/2023] [Indexed: 01/03/2024] Open
Abstract
Acute appendicitis is one of the most common non-traumatic emergency surgical pathologies, and appendix duplication is a congenital defect that is challenging to diagnose. It is often discovered incidentally during laparoscopy or laparotomy. If a double appendix or other associated anomalies are not detected, complications can be severe and potentially fatal. There are few cases of appendicular duplication. We report the incidental discovery of a double appendix in a 36-year-old man who came to the emergency department complaining of sharp right iliac fossa pain for three days and other features of appendicitis. During surgery, it was surprisingly discovered that he had two appendices. Both were inflamed, and an appendectomy was done for both of them. This case emphasizes the significance of this condition as a misdiagnosis might result in serious, potentially fatal consequences for the patient in addition to other health and legal issues.
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Affiliation(s)
| | | | | | - Mayar Aloufi
- College of Medicine, Qassim University, Qassim, SAU
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27
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Ghali MS, Saleem N, Khalaf MH, Alkubaisi IK, Ali AHJ, Al Obahi M, Al-Zoubi RM. Congenital absence of appendix: a rare condition that could result in severe complications-a review of literature. J Surg Case Rep 2023; 2023:rjad661. [PMID: 38111487 PMCID: PMC10725790 DOI: 10.1093/jscr/rjad661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Accepted: 11/18/2023] [Indexed: 12/20/2023] Open
Abstract
Acute appendicitis is the most frequent cause of abdominal pain and acute emergency surgeries, with a mortality risk of 6-7% at its onset. Since atypical deviations in these structures are rare, they can lead to diagnosis confusion and increase the risk of a worsening of the patient's clinical picture. We present the case of a 35-year-old patient who had surgery after being diagnosed with acute appendicitis. Based on clinical assessment (Alvarado score 8), appendix agenesis was discovered intraoperatively and confirmed by postoperative pathology. Excess dissection while looking for the appendix caused an intraoperative complication of cecal damage, which was treated with a right hemicolectomy. Until now, just a few cases have been described in the literature. We record this case owing to its rarity and with the goal of further understanding the illness, which will lead to improved surgical results in similar patients.
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Affiliation(s)
- Mohamed S Ghali
- Department of Surgery, Acute Care Surgery, Hamad Medical Corporation, P. O. Box 3050, Doha, Qatar
- Department of General Surgery, Ain Shams University, 11566, Cairo, Egypt
| | - Nitasha Saleem
- Department of Surgery, Acute Care Surgery, Hamad Medical Corporation, P. O. Box 3050, Doha, Qatar
| | - Mohamed H Khalaf
- Department of Surgery, Acute Care Surgery, Hamad Medical Corporation, P. O. Box 3050, Doha, Qatar
| | - Ismail K Alkubaisi
- Department of Surgery, Acute Care Surgery, Hamad Medical Corporation, P. O. Box 3050, Doha, Qatar
| | - Abdul H J Ali
- Department of Surgery, Acute Care Surgery, Hamad Medical Corporation, P. O. Box 3050, Doha, Qatar
| | - Mohammed Al Obahi
- Department of Surgery, Acute Care Surgery, Hamad Medical Corporation, P. O. Box 3050, Doha, Qatar
- College of Medicine, Qatar University, P. O. Box 2713, Doha, Qatar
| | - Raed M Al-Zoubi
- Surgical Research Section, Department of Surgery, Hamad Medical Corporation, P. O. Box 3050, Doha, Qatar
- Department of Biomedical Sciences, QU-Health, College of Health Sciences, Qatar University, P. O. Box 2713, Doha, Qatar
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Khan SA, Ashraf R, Hassaan N, Naseer M, Azad MH, Javed H. The Role of Neutrophil-to-Lymphocyte Ratio in the Diagnosis of Acute Appendicitis. Cureus 2023; 15:e51164. [PMID: 38283485 PMCID: PMC10811437 DOI: 10.7759/cureus.51164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/26/2023] [Indexed: 01/30/2024] Open
Abstract
BACKGROUND Acute appendicitis (AA), a common reason for episodes of acute abdomen, is a surgical emergency. Its immediate diagnosis and management are of immense significance, as its diagnosis can become challenging at times, especially in resource-limited setups. The goal of this study was to ascertain the threshold value for the neutrophil-to-lymphocyte ratio (NLR) in diagnosing AA and to calculate the validity parameters for the NLR. METHODOLOGY A cross-sectional study was carried out involving 108 patients who were admitted to the surgical wards of Ayub Teaching Hospital, Abbottabad with suspicion of AA and subsequently underwent open appendectomy. Data was collected regarding the demography of the patients, physical examination findings, clinical presentations, and investigations including the histopathology and complete blood count, from which the NLR value was computed, and the Statistical Package for Social Sciences (SPSS), version 25.0 (IBM Corp., Armonk, NY) was utilized for the computation. Receiver operating characteristic (ROC) analysis was done to calculate the cut-off value of the NLR for diagnosing AA, and validity parameters were computed, taking into account statistical significance with a p-value < 0.05. RESULTS Based on the ROC analysis, a threshold value for NLR indicating a positive appendectomy was determined to be 2.49 (sensitivity = 71.4% and 1-specificity = 12.5%) with an area under the curve of 90.6% (95% confidence interval {CI} 0.818-0.994, p<0.001). The sensitivity, specificity, and diagnostic accuracy of NLR for diagnosing AA were 71.43%, 87.5%, and 72.73%, respectively. CONCLUSION There is a strong correlation between NLR at a cut-off value of 2.49 and the diagnosis of AA. We suggest that NLR should be utilized as a complementary biomarker to clinical examination, aiding in the diagnosis of AA.
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Affiliation(s)
- Sundus A Khan
- General Surgery, Northwest School of Medicine, Peshawar, PAK
| | - Raza Ashraf
- General Surgery, Shifa International Hospital, Islamabad, PAK
| | - Narmeen Hassaan
- General Surgery, Shifa International Hospital, Islamabad, PAK
| | - Mubashar Naseer
- General Surgery, Shifa International Hospital, Islamabad, PAK
| | | | - Hamza Javed
- Radiology, Ayub Teaching Hospital, Abbottabad, PAK
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Nie D, Zhan Y, Xu K, Zou H, Li K, Chen L, Chen Q, Zheng W, Peng X, Yu M, Zhang S. Artificial intelligence differentiates abdominal Henoch-Schönlein purpura from acute appendicitis in children. Int J Rheum Dis 2023; 26:2534-2542. [PMID: 37905746 DOI: 10.1111/1756-185x.14956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Revised: 10/08/2023] [Accepted: 10/18/2023] [Indexed: 11/02/2023]
Abstract
OBJECTIVE This study aims to construct an artificial intelligence (AI) model capable of effectively discriminating between abdominal Henoch-Schönlein purpura (AHSP) and acute appendicitis (AA) in pediatric patients. METHODS A total of 6965 participants, comprising 2201 individuals with AHSP and 4764 patients with AA, were enrolled in the study. Additionally, 53 laboratory indicators were taken into consideration. Five distinct artificial intelligence (AI) models were developed employing machine learning algorithms, namely XGBoost, AdaBoost, Gaussian Naïve Bayes (GNB), MLPClassifier (MLP), and support vector machine (SVM). The performance of these prediction models was assessed through receiver operating characteristic (ROC) curve analysis, calibration curve assessment, and decision curve analysis (DCA). RESULTS We identified 32 discriminative indicators (p < .05) between AHSP and AA. Five indicators, namely the lymphocyte ratio (LYMPH ratio), eosinophil ratio (EO ratio), eosinophil count (EO count), neutrophil ratio (NEUT ratio), and C-reactive protein (CRP), exhibited strong performance in distinguishing AHSP from AA (AUC ≥ 0.80). Among the various prediction models, the XGBoost model displayed superior performance evidenced by the highest AUC (XGBoost = 0.895, other models < 0.89), accuracy (XGBoost = 0.824, other models < 0.81), and Kappa value (XGBoost = 0.621, other models < 0.60) in the validation set. After optimization, the XGBoost model demonstrated remarkable diagnostic performance for AHSP and AA (AUC > 0.95). Both the calibration curve and decision curve analysis suggested the promising clinical utility and net benefits of the XGBoost model. CONCLUSION The AI-based machine learning model exhibits high prediction accuracy and can differentiate AHSP and AA from a data-driven perspective.
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Affiliation(s)
- Dan Nie
- Department of General Surgery, Jiangxi Provincial Children's Hospital, Nanchang, Jiangxi, China
| | - Yishan Zhan
- Department of Rheumatology and Immunology, Jiangxi Provincial Children's Hospital, Nanchang, Jiangxi, China
| | - Kun Xu
- Department of Rheumatology and Immunology, Jiangxi Provincial Children's Hospital, Nanchang, Jiangxi, China
| | - Haibo Zou
- Department of General Surgery, Jiangxi Provincial Children's Hospital, Nanchang, Jiangxi, China
| | - Kehao Li
- Department of General Surgery, Jiangxi Provincial Children's Hospital, Nanchang, Jiangxi, China
| | - Leifeng Chen
- Department of General Surgery, Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Qiang Chen
- Department of Rheumatology and Immunology, Jiangxi Provincial Children's Hospital, Nanchang, Jiangxi, China
| | - Weiming Zheng
- Department of Nephrology, Jiangxi Provincial Children's Hospital, Nanchang, Jiangxi, China
| | - Xiaojie Peng
- Department of Nephrology, Jiangxi Provincial Children's Hospital, Nanchang, Jiangxi, China
| | - Mengjie Yu
- Key Laboratory of Drug Metabolism and Pharmacokinetics, China Pharmaceutical University, Nanjing, Jiangsu, China
| | - Shouhua Zhang
- Department of General Surgery, Jiangxi Provincial Children's Hospital, Nanchang, Jiangxi, China
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Filip F, Avramia R, Terteliu-Baitan M, Cocuz ME, Filip R. COVID-19 positive cases in a pediatric surgery department from Romania: Case series from 2 years of pandemics. Medicine (Baltimore) 2023; 102:e36235. [PMID: 38050253 PMCID: PMC10695600 DOI: 10.1097/md.0000000000036235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 10/30/2023] [Indexed: 12/06/2023] Open
Abstract
RATIONALE The COVID-19 pandemic had a dramatic effect on various health systems in terms of admissions and outcomes, including pediatric surgery activity. The aim of this paper was to analyze the outcome of SARS-CoV-2-positive patients admitted to our department during the regional COVID-19 pandemic in North-Eastern Romania. We also evaluated the changes generated in our daily practice by the COVID-19 pandemic and the dynamic response to this major challenge. PATIENT CONCERNS The patients presented with symptoms related to their primary diagnosis: local pain and deformity in case of fractures; pain, swelling, and erythema in case of abscess; pain and decreased range of motion (ROM) in case of intolerance to metal implants. Other specific concerns are mentioned on an individual basis. DIAGNOSES Eighteen patients (of which 4 had acute appendicitis and were included in a previous article), representing 1.18% of the total number of admissions, tested positive for SARS-CoV-2. There were 4 patients with fractures, 3 patients with soft tissue abscess or cellulitis, 2 patients with intolerance to metal implants, 1 patient with facial burn, 1 patient with thumb laceration, 1 patient with liver trauma, 1 patient with undescende testis, and 1 patient with symptomatic inguinal hernia, respectively. Boys represented 11/ 14 (78.57%) of the cases. The mean age of the patients was 9 years 11 months. There were only mild COVID-19 cases. INTERVENTIONS Surgery was performed in 13/ 14 (95.71%) of cases. The fractures were treated with open reduction internal fixation (ORIF); incision and drainage (I & D) were performed in case of soft tissue abscess; the metal implants were removed in case of local intolerance. Other conditions (burn, inguinal hernia, undescended testis, skin laceration) were treated specifically. Only 1 patient with liver laceration was treated conservatively under close hemodynamic monitoring. OUTCOMES The mean length of stay (LoS) was 2.71 days. The infection with the SARS-CoV-2 virus had no deleterious effect on the surgical outcome among the 14 patients included in the study. There were no surgical complications during admission and no patient returned for late complications related to their primary disease or SARS-CoV-2 infection. LESSONS The SARS-CoV-2 infection had no significant influence on the outcome of pediatric surgical cases included in the study. We noticed a significant (31.54%) decrease in the number of admissions compared to the previous 2-year interval before the COVID-19 pandemic. Fast and adequate adjustment of the daily activity imposed by the COVID-19 pandemic was feasible and may be used in the future should similar epidemiological emergencies occur.
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Affiliation(s)
- Florin Filip
- College of Medicine and Biological Sciences, Stefan cel Mare University of Suceava, Suceava, Romania
- Suceava Emergency County Hospital, Suceava, Romania
| | | | - Monica Terteliu-Baitan
- College of Medicine and Biological Sciences, Stefan cel Mare University of Suceava, Suceava, Romania
- Suceava Emergency County Hospital, Suceava, Romania
| | - Maria - Elena Cocuz
- Fundamental Prophylactic and Clinical Disciplines Department, Faculty of Medicine, Transilvania University of Brasov, Brașov, Romania
- Clinical Infectious Diseases Hospital of Brasov, Brasov, Romania
| | - Roxana Filip
- College of Medicine and Biological Sciences, Stefan cel Mare University of Suceava, Suceava, Romania
- Suceava Emergency County Hospital, Suceava, Romania
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Feng Y, Miao C, Zhao Y. Predicting Acute Appendicitis in Pregnant Patients Using the Neutrophil-to-Lymphocyte Ratio: A Meta-Analysis. Surg Infect (Larchmt) 2023; 24:903-909. [PMID: 38011746 DOI: 10.1089/sur.2023.269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2023] Open
Abstract
Background: To determine whether the neutrophil-to-lymphocyte ratio (NLR) can serve as a predictive indicator for acute appendicitis among pregnant females. Patients and Methods: A comprehensive search was conducted across multiple databases including PubMed, Embase, and Web of Science seeking to gather pertinent research on the NLR concerning pregnant individuals either suspected of or diagnosed with acute appendicitis. The NLR value and receiver operating characteristic (ROC) curve were utilized to assess the predictive value of the NLR in predicting acute appendicitis among pregnant patients. Results: Seven studies and 410 patients were included in the meta-analysis. The area under the curve (AUC) for identifying acute appendicitis in pregnant patients using the NLR was found to be 0.856 (95% confidence interval [CI], 0.833-0.879). Additionally, the NLR values for pregnant patients with acute appendicitis were significantly elevated, showing a mean difference (MD) of 0.80 (95% CI, 0.58-1.03; p < 0.001). Conclusions: The NLR can be considered a valuable and effective diagnostic tool for anticipating acute appendicitis in pregnant patients.
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Affiliation(s)
- Yangchong Feng
- Department of Obstetrics and Gynecology, Heping Hospital Affiliated to Changzhi Medical College, Changzhi, Shanxi, China
- Department of Reproductive Medicine, Heping Hospital Affiliated to Changzhi Medical College, Changzhi, Shanxi, China
| | - Chongxiu Miao
- Department of Obstetrics and Gynecology, Heping Hospital Affiliated to Changzhi Medical College, Changzhi, Shanxi, China
- Department of Reproductive Medicine, Heping Hospital Affiliated to Changzhi Medical College, Changzhi, Shanxi, China
| | - Yahui Zhao
- Department of Otorhinolaryngology, Heping Hospital Affiliated to Changzhi Medical College, Changzhi, Shanxi, China
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Delgado-Miguel C, Miguel-Ferrero M, Delgado B, Escuer Albero G, Camps J, López-Santamaría M, Hernández Oliveros F. Mucosal appendicitis: How can it be differentiated from nonappendicitis? Am J Clin Pathol 2023; 160:500-506. [PMID: 37477500 DOI: 10.1093/ajcp/aqad079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2023] [Accepted: 06/21/2023] [Indexed: 07/22/2023] Open
Abstract
OBJECTIVES Mucosal appendicitis is defined by neutrophilic infiltration limited to the mucosa, with no transmural invasion; it is currently a controversial entity. The aim of our study was to determine whether mucosal appendicitis represents an early stage of acute appendicitis (AA) or should be considered a negative appendectomy. METHODS A retrospective study was performed of children with suspected AA who underwent surgical treatment between 2017 and 2020. The participants were divided into 2 groups according to histologic appendiceal findings: mucosal appendicitis (MA) and negative appendicitis (NA). Demographic, clinical, ultrasound, and laboratory features were compared between the groups. RESULTS A total of 1269 patients with suspected appendicitis in whom appendectomy was performed were included, with a median age of 10.5 years. Mucosal appendiceal inflammation was histologically confirmed in 30 cases (MA group), while no inflammation or other pathologic findings were observed in 25 cases (NA group), with no differences in demographic, clinical, or ultrasound features between the groups. Those in the MA group presented with significantly higher leukocyte and neutrophil counts and higher neutrophil to lymphocyte ratios (NLRs) than those in the NA group (P < .001). The NLR was the parameter with the highest area under the curve (0.736) for the diagnosis of MA. A cutoff of 3.20 was established, with a maximum sensitivity and specificity of 62.5% and 78.9%, respectively. CONCLUSIONS Mucosal appendicitis presents with laboratory and histologic inflammatory features that can be distinguished from nonappendicitis and should therefore be considered a pathologic entity within the spectrum of AA. Preoperative leukocyte and neutrophil counts and NLRs may help reduce the number of negative appendectomies.
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Affiliation(s)
- Carlos Delgado-Miguel
- Department of Pediatric Surgery, Prisma Health Children's Hospital, Columbia, SC, US
- Department of Pediatric Surgery, La Paz Children's Hospital, Madrid, Spain
- Institute for Biomedical Research La Paz (IdiPaz), La Paz University Hospital, Madrid, Spain
| | | | - Bonifacio Delgado
- Department of Mathematics, Complutense University of Madrid, Madrid, Spain
| | | | - Juan Camps
- Department of Pediatric Surgery, Prisma Health Children's Hospital, Columbia, SC, US
| | | | - Francisco Hernández Oliveros
- Department of Pediatric Surgery, La Paz Children's Hospital, Madrid, Spain
- Department of Mathematics, Complutense University of Madrid, Madrid, Spain
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Wazzan M, Abduljabbar A, Khizindar H, Alzahrani A, Aljohani RM, Nahas R, Aman R, Tawfiq S, Aldajani A. Up-to-Date Diagnostic CT Standards for Acute Appendicitis: Wall Thickness and Intraluminal Fluid Thickness. Cureus 2023; 15:e48154. [PMID: 37965237 PMCID: PMC10643053 DOI: 10.7759/cureus.48154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/02/2023] [Indexed: 11/16/2023] Open
Abstract
Acute appendicitis is a prevalent condition that requires accurate and timely diagnosis and management to avoid potential complications. Classically, the diagnosis of appendicitis is made using the appendicular outer-to-outer wall diameter. In this study, we examined the sensitivity and specificity of computed tomography (CT) scans for diagnosing acute appendicitis using wall thickness and lumen thickness rather than diameter. This study included data from 350 patients who presented to the emergency department with clinically suspected acute appendicitis. All patients underwent a CT scan, and 62 radiologically positive patients underwent surgery. A radiological diagnosis was made using the conventional outer-to-outer wall diameter with a cut-off of 6 mm for a positive diagnosis. These 62 positive CT scans were reviewed and compared with surgical results. The study showed that a threshold of 2.25 mm for appendicular lumen thickness is an excellent diagnostic tool for acute appendicitis, demonstrating a high sensitivity of 96.4% and a lower specificity of 67%. In contrast, 1.6 mm wall thickness indicates acute appendicitis, with 81.8% sensitivity and 84% specificity. However, the wall thickness remains inferior to the conventionally used measurement of 6.75 mm for appendicular diameter, with a sensitivity of 87.5% and a specificity of 100%.
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Affiliation(s)
- Mohammad Wazzan
- Department of Radiology, King Abdulaziz University Faculty of Medicine, Jeddah, SAU
| | - Ahmed Abduljabbar
- Department of Radiology, King Abdulaziz University Faculty of Medicine, Jeddah, SAU
| | - Huda Khizindar
- Department of Radiology, King Abdulaziz University Faculty of Medicine, Jeddah, SAU
| | - Aghnar Alzahrani
- Department of Medicine and Surgery, Albaha University, Baha, SAU
| | - Renad M Aljohani
- Department of Medicine, King Saud Bin Abdulaziz University for Health Sciences College of Medicine, Riyadh, SAU
| | - Rana Nahas
- Department of Medicine, Faculty of Medicine, Ibn Sina National College, Jeddah, SAU
| | - Rahf Aman
- Department of Medicine and Surgery, Batterjee Medical College, Jeddah, SAU
| | - Shouq Tawfiq
- Department of Medicine and Surgery, King Faisal University, Jeddah, SAU
| | - Arwa Aldajani
- Department of Medicine and Surgery, Alfaisal University College of Medicine, Riyadh, SAU
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Harmantepe AT, Dikicier E, Gönüllü E, Ozdemir K, Kamburoğlu MB, Yigit M. A different way to diagnosis acute appendicitis: machine learning. Pol Przegl Chir 2023; 96:38-43. [PMID: 38629278 DOI: 10.5604/01.3001.0053.5994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/19/2024]
Abstract
<b><br>Indroduction:</b> Machine learning is a branch of artificial intelligence based on the idea that systems can learn from data, identify patterns, and make decisions with minimal human intervention.</br> <b><br>Aim:</b> Our aim is to predict acute appendicitis, which is the most common indication for emergency surgery, using machine learning algorithms with an easy and inexpensive method.</br> <b><br>Materials and methods:</b> Patients who were treated surgically with a prediagnosis of acute appendicitis in a single center between 2011 and 2021 were analyzed. Patients with right lower quadrant pain were selected. A total of 189 positive and 156 negative appendectomies were found. Gender and hemogram were used as features. Machine learning algorithms and data analysis were made in Python (3.7) programming language.</br> <b><br>Results:</b> Negative appendectomies were found in 62% (n = 97) of the women and in 38% (n = 59) of the men. Positive appendectomies were present in 38% (n = 72) of the women and 62% (n = 117) of the men. The accuracy in the test data was 82.7% in logistic regression, 68.9% in support vector machines, 78.1% in k-nearest neighbors, and 83.9% in neural networks. The accuracy in the voting classifier created with logistic regression, k-nearest neighbor, support vector machines, and artificial neural networks was 86.2%. In the voting classifier, the sensitivity was 83.7% and the specificity was 88.6%.</br> <b><br>Conclusions:</b> The results of our study show that machine learning is an effective method for diagnosing acute appendicitis. This study presents a practical, easy, fast, and inexpensive method to predict the diagnosis of acute appendicitis.</br>.
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Affiliation(s)
| | - Enis Dikicier
- Sakarya University Faculty of Medicine, Department of General Surgery
| | - Emre Gönüllü
- Sakarya University Education and Research Hospital, Department of General Surgery
| | | | | | - Merve Yigit
- Sakarya University Education and Research Hospital, Department of General Surgery
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Mehbub H, Baig AA, Khalid R, Mehmood MS, Ur Rehman O, Ghani U, Ahmad A. A Comparison of the Modified Alvarado Score and the Raja Isteri Pengiran Anak Saleha Appendicitis (Ripasa) Score in a Southeast Asian Population With Histopathology as the Gold Standard. Cureus 2023; 15:e46715. [PMID: 38021985 PMCID: PMC10630786 DOI: 10.7759/cureus.46715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/09/2023] [Indexed: 12/01/2023] Open
Abstract
Background The diagnosis of acute appendicitis has remained difficult despite it being one of the most common surgical emergencies in the world. One of the most frequently used scoring systems is the Modified Alvarado Score (MAS). However, the MAS has been known to be less efficient in Asian populations. To overcome this issue, the Raja Isteri Pengiran Anak Saleha Appendicitis (RIPASA) score has been specifically developed to improve the diagnosis of acute appendicitis in Asian populations. This study aimed to evaluate the accuracy of the RIPASA score compared to the MAS for the diagnosis of acute appendicitis in a Southeast Asian population keeping histopathology as the gold standard. Methodology The study group comprised 150 patients. Data were collected from each patient using a simple proforma to ascertain both the MAS and the RIPASA score for each patient at the time of presentation. The patients then underwent open appendectomy and histopathology was used as the gold standard to determine the presence or absence of acute appendicitis in the excised specimens. Results The RIPASA score had a sensitivity and specificity of 89.83% and 59.38%, respectively, compared to 64.41% and 53.12%, respectively, for the MAS. Diagnostic accuracy was similarly higher for the RIPASA score at 83.33% versus 62.00% for the MAS. Conclusions The RIPASA score is superior to the MAS for the diagnosis of acute appendicitis. Using the RIPASA score instead of the MAS in Southeast Asian populations can lead to a more accurate and timely clinical diagnosis of patients with suspected acute appendicitis and help improve patient outcomes.
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Affiliation(s)
- Hummaz Mehbub
- General Surgery, Akhtar Saeed Medical and Dental College, Lahore, PAK
| | - Aftab A Baig
- General Surgery, Akhtar Saeed Medical and Dental College, Lahore, PAK
| | - Rizwan Khalid
- General Surgery, Akhtar Saeed Medical and Dental College, Lahore, PAK
| | | | | | - Usman Ghani
- General Surgery, Akhtar Saeed Medical and Dental College, Lahore, PAK
| | - Ashfaq Ahmad
- General Surgery, Akhtar Saeed Medical and Dental College, Lahore, PAK
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Elkhawaga M, Alam AS, Eldomiaty A. Combined Laparoscopic Open Surgical Approach for De Garengeot's Hernia Containing an Inflamed Appendix: A Case Report. Cureus 2023; 15:e46877. [PMID: 37954737 PMCID: PMC10638476 DOI: 10.7759/cureus.46877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/11/2023] [Indexed: 11/14/2023] Open
Abstract
De Garengeot hernia represents a rare variant of femoral hernia in which the appendix is a part of the hernial contents. It was first described in 1731 by a French surgeon, René de Garengeot. In 1785, Hevin was the first to perform an appendectomy to address acute appendicitis within the context of a femoral hernia. The development of acute appendicitis in the femoral hernia sac becomes a surgical emergency of the acute abdomen.
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Affiliation(s)
| | - Ahmad S Alam
- General Surgery, John Hunter Hospital, Newcastle, AUS
| | - Amro Eldomiaty
- Emergency Department, Al-Rwad Specialized Hospital, Menouf, EGY
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Radboy M, Kalantari ME, Einafshar N, Zandbaf T, Bagherzadeh AA, Shari’at Moghani M. Amyand hernia as a rare cause of abdominal pain: A case report and literature review. Clin Case Rep 2023; 11:e7929. [PMID: 37780933 PMCID: PMC10533375 DOI: 10.1002/ccr3.7929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2023] [Revised: 08/27/2023] [Accepted: 08/29/2023] [Indexed: 10/03/2023] Open
Abstract
Key Clinical Message Amyand's hernia is an uncommon kind of inguinal hernia in which the appendix becomes entrapped within the hernia sac. In patients with an inflamed or perforated appendix, mesh repair is not recommended for hernia repair. Abstract Amyand's hernia is an uncommon kind of inguinal hernia in which the appendix becomes entrapped within the hernia sac. We report a 48-year-old man with a right groin protrusion and abdominal pain. In the abdominopelvic ultrasound, an appendix with a diameter of 9 mm was reported in the right inguinal canal. The patient was diagnosed with Amyand hernia.
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Affiliation(s)
- Mahsa Radboy
- Innovative Medical Research Center, Faculty of Medicine, Mashhad Medical SciencesIslamic Azad UniversityMashhadIran
| | | | - Negar Einafshar
- Innovative Medical Research Center, Faculty of Medicine, Mashhad Medical SciencesIslamic Azad UniversityMashhadIran
| | - Tooraj Zandbaf
- Department of General Surgery, Faculty of Medicine, Mashhad Medical SciencesIslamic Azad UniversityMashhadIran
| | - Ali Akbar Bagherzadeh
- Innovative Medical Research Center, Faculty of Medicine, Mashhad Medical SciencesIslamic Azad UniversityMashhadIran
| | - Mahta Shari’at Moghani
- Innovative Medical Research Center, Faculty of Medicine, Mashhad Medical SciencesIslamic Azad UniversityMashhadIran
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Ding H, Li Y. Effect of endoscopic loop ties in acute appendicitis on wound infection rate: A meta-analysis. Int Wound J 2023; 20:3048-3056. [PMID: 37165758 PMCID: PMC10502295 DOI: 10.1111/iwj.14180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2023] [Revised: 03/21/2023] [Accepted: 03/27/2023] [Indexed: 05/12/2023] Open
Abstract
A meta-analysis study to measure the consequence of endoscopic loop ties (ELT) in acute appendicitis (AA) on wound infection rate. A comprehensive literature inspection till February 2023 was applied and 2765 interrelated studies were reviewed. The 27 chosen studies enclosed 15 093 subjects with AA in the chosen studies' starting point, 7141 of them were ELT, and 7952 were open surgery. Odds ratio (OR) in addition to 95% confidence intervals (CIs) were used to compute the value of the effect of ELT in AA on wound infection rate by the dichotomous and continuous styles and a fixed or random model. Open surgery had a significantly higher postoperative surgical site wound infection (SSWI). (OR, 1.41; 95% CI, 1.09-1.83, P = 0.009) with low heterogeneity (I2 = 34%) compared to ELT in AA subjects. Although no significant difference was detected between open surgery and ELT in intra-abdominal abscess rate (OR, 0.88; 95% CI, 0.56-1.40, P = 0.59) with moderate heterogeneity (I2 = 51%) in AA subjects. Open surgery had a significantly higher postoperative SSWI, however, no significant difference was found in intra-abdominal abscess rate compared to ELT in AA subjects. However, caused by the small sample sizes of several chosen studies for this meta-analysis, care must be exercised when dealing with its values.
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Affiliation(s)
- Hongling Ding
- Department of Digestive Internal MedicineThe First Hospital of Zibo CityZiboChina
| | - Yong Li
- Department of Digestive Internal MedicineThe First Hospital of Zibo CityZiboChina
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Alius C, Serban D, Tribus LC, Costea DO, Cristea BM, Serboiu C, Motofei I, Dascalu AM, Velescu B, Tudor C, Socea B, Bobirca A, Vancea G, Tanasescu D, Bratu DG. When Not to Operate on Acute Cases-A Surgeon's Perspective on Rapid Assessment of Emergency Abdominopelvic Computed Tomography. J Imaging 2023; 9:200. [PMID: 37888307 PMCID: PMC10607302 DOI: 10.3390/jimaging9100200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2023] [Revised: 09/21/2023] [Accepted: 09/25/2023] [Indexed: 10/28/2023] Open
Abstract
Clinical problem solving evolves in parallel with advances in technology and discoveries in the medical field. However, it always reverts to basic cognitive processes involved in critical thinking, such as hypothetical-deductive reasoning, pattern recognition, and compilation models. When dealing with cases of acute abdominal pain, clinicians should employ all available tools that allow them to rapidly refine their analysis for a definitive diagnosis. Therefore, we propose a standardized method for the quick assessment of abdominopelvic computed tomography as a supplement to the traditional clinical reasoning process. This narrative review explores the cognitive basis of errors in reading imaging. It explains the practical use of attenuation values, contrast phases, and windowing for non-radiologists and details a multistep protocol for finding radiological cues during CT reading and interpretation. This systematic approach describes the salient features and technical tools needed to ascertain the causality between clinical patterns and abdominopelvic changes visible on CT scans from a surgeon's perspective. It comprises 16 sections that should be read successively and that cover the entire abdominopelvic region. Each section details specific radiological signs and provides clear explanations for targeted searches, as well as anatomical and technical hints. Reliance on imaging in clinical problem solving does not make a decision dichotomous nor does it guarantee success in diagnostic endeavors. However, it contributes exact information for supporting the clinical assessments even in the most subtle and intricate conditions.
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Affiliation(s)
- Catalin Alius
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy Bucharest, 020021 Bucharest, Romania; (C.A.); (B.M.C.); (C.S.); (I.M.); (A.M.D.); (C.T.); (B.S.); (A.B.); (G.V.)
- Fourth General Surgery Department, Emergency University Hospital Bucharest, 050098 Bucharest, Romania
| | - Dragos Serban
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy Bucharest, 020021 Bucharest, Romania; (C.A.); (B.M.C.); (C.S.); (I.M.); (A.M.D.); (C.T.); (B.S.); (A.B.); (G.V.)
- Fourth General Surgery Department, Emergency University Hospital Bucharest, 050098 Bucharest, Romania
| | - Laura Carina Tribus
- Faculty of Dental Medicine, Carol Davila University of Medicine and Pharmacy Bucharest, 020021 Bucharest, Romania
- Department of Internal Medicine, Ilfov Emergency Clinic Hospital Bucharest, 022104 Bucharest, Romania
| | - Daniel Ovidiu Costea
- Faculty of Medicine, Ovidius University Constanta, 900470 Constanta, Romania;
- General Surgery Department, Emergency County Hospital Constanta, 900591 Constanta, Romania
| | - Bogdan Mihai Cristea
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy Bucharest, 020021 Bucharest, Romania; (C.A.); (B.M.C.); (C.S.); (I.M.); (A.M.D.); (C.T.); (B.S.); (A.B.); (G.V.)
| | - Crenguta Serboiu
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy Bucharest, 020021 Bucharest, Romania; (C.A.); (B.M.C.); (C.S.); (I.M.); (A.M.D.); (C.T.); (B.S.); (A.B.); (G.V.)
| | - Ion Motofei
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy Bucharest, 020021 Bucharest, Romania; (C.A.); (B.M.C.); (C.S.); (I.M.); (A.M.D.); (C.T.); (B.S.); (A.B.); (G.V.)
- Department of General Surgery, Emergency Clinic Hospital “Sf. Pantelimon” Bucharest, 021659 Bucharest, Romania
| | - Ana Maria Dascalu
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy Bucharest, 020021 Bucharest, Romania; (C.A.); (B.M.C.); (C.S.); (I.M.); (A.M.D.); (C.T.); (B.S.); (A.B.); (G.V.)
| | - Bruno Velescu
- Faculty of Pharmacy, Carol Davila University of Medicine and Pharmacy Bucharest, 020021 Bucharest, Romania
| | - Corneliu Tudor
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy Bucharest, 020021 Bucharest, Romania; (C.A.); (B.M.C.); (C.S.); (I.M.); (A.M.D.); (C.T.); (B.S.); (A.B.); (G.V.)
- Fourth General Surgery Department, Emergency University Hospital Bucharest, 050098 Bucharest, Romania
| | - Bogdan Socea
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy Bucharest, 020021 Bucharest, Romania; (C.A.); (B.M.C.); (C.S.); (I.M.); (A.M.D.); (C.T.); (B.S.); (A.B.); (G.V.)
- Department of General Surgery, Emergency Clinic Hospital “Sf. Pantelimon” Bucharest, 021659 Bucharest, Romania
| | - Anca Bobirca
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy Bucharest, 020021 Bucharest, Romania; (C.A.); (B.M.C.); (C.S.); (I.M.); (A.M.D.); (C.T.); (B.S.); (A.B.); (G.V.)
| | - Geta Vancea
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy Bucharest, 020021 Bucharest, Romania; (C.A.); (B.M.C.); (C.S.); (I.M.); (A.M.D.); (C.T.); (B.S.); (A.B.); (G.V.)
- Clinical Hospital of Infectious and Tropical Diseases “Dr. Victor Babes”, 030303 Bucharest, Romania
| | - Denisa Tanasescu
- Department of Nursing and Dentistry, Faculty of General Medicine, ‘Lucian Blaga’ University of Sibiu, 550169 Sibiu, Romania;
| | - Dan Georgian Bratu
- Faculty of Medicine, University “Lucian Blaga”, 550169 Sibiu, Romania;
- Department of Surgery, Emergency County Hospital Sibiu, 550245 Sibiu, Romania
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Turki A, Raml E. Enhancing Pediatric Adnexal Torsion Diagnosis: Prediction Method Utilizing Machine Learning Techniques. Children (Basel) 2023; 10:1612. [PMID: 37892275 PMCID: PMC10605566 DOI: 10.3390/children10101612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 09/09/2023] [Accepted: 09/25/2023] [Indexed: 10/29/2023]
Abstract
This study systematically examines pediatric adnexal torsion, proposing a diagnostic approach using machine learning techniques to distinguish it from acute appendicitis. Our retrospective analysis involved 41 female pediatric patients divided into two groups: 21 with adnexal torsion (group 1) and 20 with acute appendicitis (group 2). In group 1, the average age was 10 ± 2.6 years, while in group 2, it was 9.8 ± 21.9 years. Our analysis found no statistically significant age distinctions between these two groups. Despite acute lower abdominal pain being a common factor, group 1 displayed shorter pain duration (28.9 h vs. 46.8 h, p < 0.05), less vomiting (28% vs. 50%, p < 0.05), lower fever incidence (4.7% vs. 50%, p < 0.05), reduced leukocytosis (57% vs. 75%, p < 0.05), and CRP elevation (30% vs. 80%, p < 0.05) compared to group 2. Machine learning techniques, specifically support vector classifiers, were employed using clinical presentation, pain duration, white blood cell counts, and ultrasound findings as features. The classifier consistently demonstrated an average predictive accuracy of 87% to 97% in distinguishing adnexal torsion from appendicitis, as confirmed across various SVM models employing different kernels. Our findings emphasize the capacity of support vector machines (SVMs) and machine learning as a whole to augment diagnostic accuracy when distinguishing between adnexal torsion and acute appendicitis. Nevertheless, it is imperative to validate these results through more extensive investigations and explore alternative machine learning models for a comprehensive understanding of their diagnostic capabilities.
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Affiliation(s)
- Ahmad Turki
- Electrical and Computer Engineering Department, Faculty of Engineering, King Abdulaziz University, Jeddah 21589, Saudi Arabia
- Center of Excellence in Intelligent Engineering Systems, King Abdulaziz University, Jeddah 21589, Saudi Arabia
| | - Enas Raml
- Pediatric Surgery Department, Faculty of Medicine, King Abdulaziz University, Jeddah 21589, Saudi Arabia;
- Pediatric Surgery Department, International Medical Center, Jeddah 23214, Saudi Arabia
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Guňková P, Tulinský L, Toman D, Martínek L, Vrtková A, Špaček R, Šimetka O. Acute appendicitis in pregnancy - do we treat correctly, or do we delay unnecessarily? Ginekol Pol 2023; 95:126-131. [PMID: 37668390 DOI: 10.5603/gpl.95367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2023] [Accepted: 05/29/2023] [Indexed: 09/06/2023] Open
Abstract
OBJECTIVES Acute appendicitis is the most common non-gynaecological indication for surgical intervention during pregnancy. The aim of this study was to compare perioperative and postoperative results of surgical treatment of acute appendicitis in the early and late stage of pregnancy. MATERIAL AND METHODS This is a retrospective study focused on the evaluation of perioperative and postoperative results of appendectomy in pregnancy. The study included all pregnant patients who underwent laparoscopic or open appendectomy at the University Hospital Ostrava during the observed 10-year period (January 2012-December 2021). The patients were divided into two subgroups according to the stage of pregnancy in relation to the expected viability of the foetus (the viability limit was defined as the 23rd week of pregnancy). RESULTS In the monitored 10-year period, a total of 25 pregnant patients underwent appendectomy. Comparing the two subgroups of patients, there were no statistically significant differences in any of the admission parameters. Laparoscopy was performed in 100% of the patients in the lower stage of pregnancy (< 23 g.w.) and in 61% of the subgroup of patients with more advanced pregnancy (> 23 g.w.); this difference was statistically significant (p = 0.039). Differences in subgroups regarding duration of surgery, risk of revision and 30-day postoperative morbidity were not statistically significant. In the subgroup of patients < 23 g.w., uncomplicated forms of appendicitis predominated (66%), whereas in the subgroup > 23 g.w., complicated forms predominated (69%); this difference was statistically significant (p = 0.026). When comparing the two subgroups of patients, there was a statistically significant difference in the length of hospitalization (p = 0.006). The mortality rate of the group was zero. CONCLUSIONS The results of the study confirm the fact that advanced pregnancy may be related to complicated forms of appendicitis. Therefore, early appendectomy is still the method of choice. In accordance with the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) recommendations, laparoscopic approach is preferred in pregnant patients, even in advanced pregnancy.
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Affiliation(s)
- Petra Guňková
- Department of Surgery, University Hospital Ostrava, Czech Republic
- Department of Surgical Studies, Faculty of Medicine, University of Ostrava, Czech Republic
| | - Lubomír Tulinský
- Department of Surgery, University Hospital Ostrava, Czech Republic.
- Department of Surgical Studies, Faculty of Medicine, University of Ostrava, Czech Republic.
| | - Daniel Toman
- Department of Surgery, University Hospital Ostrava, Czech Republic
- Department of Surgical Studies, Faculty of Medicine, University of Ostrava, Czech Republic
| | - Lubomír Martínek
- Department of Surgery, University Hospital Ostrava, Czech Republic
- Department of Surgical Studies, Faculty of Medicine, University of Ostrava, Czech Republic
| | - Adéla Vrtková
- Department of Applied Mathematics, Faculty of Electrical Engineering and Computer Science, VSB - Technical University of Ostrava, Czech Republic, Czech Republic
- Department of Deputy Director for Science, Research and Education, University Hospital Ostrava, Czech Republic
| | - Richard Špaček
- Department of Gynaecology and Obstetrics University Hospital Ostrava, Czech Republic
| | - Ondřej Šimetka
- Department of Gynaecology and Obstetrics University Hospital Ostrava, Czech Republic
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Thompson L, Cohen BL, Wolde T, Yeh DD, Ramsey WA, Byers PM, Namias N, Meizoso JP. Open Versus Laparoscopic Appendectomy: A Post Hoc Analysis of the EAST Appendicitis MUSTANG Study. Surg Infect (Larchmt) 2023; 24:613-618. [PMID: 37646633 DOI: 10.1089/sur.2023.109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/01/2023] Open
Abstract
Background: We sought to understand which factors are associated with open appendectomy as final operative approach. We hypothesize that higher American Association for the Surgery of Trauma (AAST) Emergency General Surgery (EGS) grade is associated with open appendectomy. Patients and Methods: Post hoc analysis of the Eastern Association for the Surgery of Trauma (EAST) Multicenter Study of the Treatment of Appendicitis in America: Acute, Perforated and Gangrenous (MUSTANG) prospective appendicitis database was performed. All adults (age >18) undergoing appendectomy were stratified by final operative approach: laparoscopic or open appendectomy (including conversion from laparoscopic). Univariable analysis was performed to compare group characteristics and outcomes, and multivariable logistic regression was performed to identify demographic, clinical, or radiologic factors associated with open appendectomy. Results: A total of 3,019 cases were analyzed. One hundred seventy-five (5.8%) patients underwent open appendectomy, including 127 converted from laparoscopic to open. The median age was 37 (25) years and 53% were male. Compared with the laparoscopic group, open appendectomy patients had more comorbidities, higher proportion of symptoms greater than 96 hours, and higher AAST EGS grade. Moreover, on intraoperative findings, the open appendectomy group had a higher incidence of perforated and gangrenous appendicitis with purulent contamination, abscess/phlegmon, and purulent abdominal/pelvic fluid. On multivariable analysis controlling for comorbidities, clinical and imaging AAST grade, duration of symptoms, and intra-operative findings, only AAST Clinical Grade 5 appendicitis was independently associated with open appendectomy (odds ratio [OR], 5.63; 95% confidence interval [CI], 1.24-25.55; p = 0.025). Conclusions: In the setting of appendicitis, generalized peritonitis (AAST Clinical Grade 5) is independently associated with greater odds of open appendectomy.
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Affiliation(s)
- Lauren Thompson
- DeWitt Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
- Ryder Trauma Center, Jackson Memorial Hospital, Miami, Florida, USA
- Department of Surgery, Florida Atlantic University, Boca Raton, Florida, USA
| | - Brianna L Cohen
- DeWitt Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
- Ryder Trauma Center, Jackson Memorial Hospital, Miami, Florida, USA
| | - Tizeta Wolde
- DeWitt Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - D Dante Yeh
- Department of Surgery, Denver Health Medical Center, Denver, Colorado, USA
| | - Walter A Ramsey
- DeWitt Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
- Ryder Trauma Center, Jackson Memorial Hospital, Miami, Florida, USA
| | - Patricia M Byers
- DeWitt Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
- Ryder Trauma Center, Jackson Memorial Hospital, Miami, Florida, USA
| | - Nicholas Namias
- DeWitt Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
- Ryder Trauma Center, Jackson Memorial Hospital, Miami, Florida, USA
| | - Jonathan P Meizoso
- DeWitt Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
- Ryder Trauma Center, Jackson Memorial Hospital, Miami, Florida, USA
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Treviño-Arizmendi CJ, Garza-Castillo JJ, Saldívar-Rubio JA, García-Arroyo K, López-Vidal WL, Alvarado-Gómez JA, Lozano-Carrillo LC, Nery-López GC, Martínez-Puente DH, Muñoz-Maldonado GE. Small Cell Neuroendocrine Carcinoma of the Lung Discovered by Acute Appendicitis Metastasis: An Experience at Our Hospital. Cureus 2023; 15:e45732. [PMID: 37868387 PMCID: PMC10590259 DOI: 10.7759/cureus.45732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/21/2023] [Indexed: 10/24/2023] Open
Abstract
Acute appendicitis is the most common cause of abdominal pain that requires surgery. Appendiceal cancer is rare, comprising nearly 4% of all gastrointestinal diagnoses. It is common to find neuroendocrine neoplasms due to metastasis in this site. Appendix tumors are usually asymptomatic; however, if they are advanced or have metastases, they can cause abdominal symptoms. Computed tomography (CT) is commonly used to diagnose acute appendicitis in these cases. CT usually shows an increased appendiceal diameter with thickening (>3 mm) of the appendiceal wall, an intraluminal fluid depth >2.6 mm, and periappendiceal inflammation. Histopathological findings confirm the diagnosis. Medical and surgical management depends on physical characteristics such as size, location, and degree of evolution. We present the case of a 77-year-old woman with a family history of well-controlled type 2 diabetes mellitus and hypertension. She was referred to our institution after four days of abdominal pain in the epigastrium and both flanks accompanied by fever. An abdominal CT showed left pleural effusion and appendicular thickening. Laboratory tests showed high blood glucose levels, leukocytosis at the expense of neutrophils, an increased platelet count, and decreased albumin and total proteins. The CT scan also showed a calcified granuloma in the anterior segment of the right upper lobe and an irregular image with partially defined hypodense borders in the liver in segment IVb. We report our experience with the diagnosis, management, and treatment decisions of this case. It is important to mention that the first diagnosis was acute appendicitis. This diagnosis motivated us to seek other symptoms and signs by direct questioning and imaging studies leading us to diagnose metastatic lung cancer.
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Affiliation(s)
- César J Treviño-Arizmendi
- General Surgery, "Dr. José Eleuterio Gonzalez" University Hospital at the Autonomous University of Nuevo León, Monterrey, MEX
| | - Jorge J Garza-Castillo
- General Surgery, "Dr. José Eleuterio Gonzalez" University Hospital at the Autonomous University of Nuevo León, Monterrey, MEX
| | - Jesús A Saldívar-Rubio
- Emergency, "Dr. José Eleuterio Gonzalez" University Hospital at the Autonomous University of Nuevo León, Monterrey, MEX
| | - Karla García-Arroyo
- Emergency, "Dr. José Eleuterio Gonzalez" University Hospital at the Autonomous University of Nuevo León, Monterrey, MEX
| | - Williams L López-Vidal
- Emergency, "Dr. José Eleuterio Gonzalez" University Hospital at the Autonomous University of Nuevo León, Monterrey, MEX
| | - Julio A Alvarado-Gómez
- Emergency, "Dr. José Eleuterio Gonzalez" University Hospital at the Autonomous University of Nuevo León, Monterrey, MEX
| | - Luis C Lozano-Carrillo
- Emergency, "Dr. José Eleuterio Gonzalez" University Hospital at the Autonomous University of Nuevo León, Monterrey, MEX
| | - Grecia C Nery-López
- Emergency, "Dr. José Eleuterio Gonzalez" University Hospital at the Autonomous University of Nuevo León, Monterrey, MEX
| | - David H Martínez-Puente
- Histology, Faculty of Medicine, "Dr. José Eleuterio Gonzalez" University Hospital at the Autonomous University of Nuevo León, Monterrey, MEX
- Physiology, Biophysics, and Neurosciences, Center for Research and Advanced Studies of the National Polytechnic Institute, Mexico City, MEX
| | - Gerardo E Muñoz-Maldonado
- General Surgery, "Dr. José Eleuterio Gonzalez" University Hospital at the Autonomous University of Nuevo León, Monterrey, MEX
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44
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Francis MA, Nerella R, Francis DT, Raj R, Zain A, Augustine S, Jamil NA. Acute Appendicitis with Appendicolith and its Complication and Management: A Case Report. Cureus 2023; 15:e45715. [PMID: 37868373 PMCID: PMC10590198 DOI: 10.7759/cureus.45715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/21/2023] [Indexed: 10/24/2023] Open
Abstract
Acute appendicitis is a common cause of acute abdominal pain requiring urgent surgery. Despite characteristic clinical signs, diagnosis can be challenging, leading to unnecessary appendectomies. This case report focuses on a 34-year-old male with escalating right lower quadrant abdominal pain. Imaging revealed acute appendicitis with a substantial appendicolith. Surgical intervention involved a open appendectomy with possible ileocecal resection due to cecal inflamation. Surgical findings indicated successful resection, and the patient recovered without complications. While urgent appendectomy is the norm, conservative approaches are gaining traction for peri-appendiceal abscesses. Interval appendectomy post-conservative treatment is a debated strategy. Management decisions are influenced by patient factors and disease severity. Future research is needed to establish standardized treatment protocols for complicated appendicitis. The case illustrates the evolving landscape of acute appendicitis management.
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Affiliation(s)
- Maya Ann Francis
- Internal Medicine, Windsor University School of Medicine, Cayon, KNA
| | - Resheek Nerella
- Trauma Surgery, University of Illinois College of Medicine Peoria (UICOMP), Peoria, USA
| | | | - Rohan Raj
- Internal Medicine, Nalanda Medical College and Hospital, Patna, IND
| | - Ahmer Zain
- General Medicine, Kempegowda Institute of Medical Sciences, Bangalore, IND
| | - Sana Augustine
- Internal Medicine, Liaquat University of Medical and Health Sciences, Jamshoro, PAK
| | - Niyaz A Jamil
- Trauma Surgery, University of Illinois/OSF St Francis Medical Center, Peoria, USA
- Surgery, Windsor University School of Medicine, Cayon, KNA
- Surgery, Combined Military Hospital, Nowshera, PAK
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45
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Gürpınar Tosun B, Karagözlü Akgül A, Almus E, Abidoğlu S, Turan S, Bereket A, Güran T. Non-hormonal Clitoromegaly due to Clitoral Priapism Caused by Appendicitis/Appendectomy. J Clin Res Pediatr Endocrinol 2023; 15:324-328. [PMID: 34866370 PMCID: PMC10448556 DOI: 10.4274/jcrpe.galenos.2021.2021-8-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Accepted: 11/17/2021] [Indexed: 12/01/2022] Open
Abstract
Clitoromegaly usually develops due to hyperandrogenism. There are a few cases of clitoromegaly described without clinical and biochemical hyperandrogenism. Clitoromegaly due to clitoral priapism and clitoral priapism after appendectomy have not been reported previously. A 7-year-old girl was referred for enlargement of the clitoris. She reported having a mild, pulsating clitoral pain starting three days after an appendectomy operation. Subsequently, painful swelling and an increase in the size of the clitoris was observed. Her growth and physical examination were otherwise normal. Causes of the clitoromegaly due to androgen excess were excluded after a comprehensive work-up. Color Doppler ultrasound revealed a high peak systolic velocity and resistance in the cavernosal artery, consistent with clitoral priapism. The clitoromegaly and associated symptoms improved significantly with oral pseudoephedrine and intracavernosal aspiration. This unique case illustrates that clitoral priapism is a rare, non-hormonal cause of clitoromegaly and may occur after appendectomy. Pseudoephedrine treatment is helpful in alleviating the symptoms.
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Affiliation(s)
- Büşra Gürpınar Tosun
- Marmara University Faculty of Medicine, Department of Pediatric Endocrinology and Diabetes, İstanbul, Turkey
| | - Ahsen Karagözlü Akgül
- Marmara University Faculty of Medicine, Department of Pediatric Urology, İstanbul, Turkey
| | - Eda Almus
- Marmara University Faculty of Medicine, Department of Pediatric Radiology, İstanbul, Turkey
| | - Sadık Abidoğlu
- Marmara University Faculty of Medicine, Department of Pediatric Urology, İstanbul, Turkey
| | - Serap Turan
- Marmara University Faculty of Medicine, Department of Pediatric Endocrinology and Diabetes, İstanbul, Turkey
| | - Abdullah Bereket
- Marmara University Faculty of Medicine, Department of Pediatric Endocrinology and Diabetes, İstanbul, Turkey
| | - Tülay Güran
- Marmara University Faculty of Medicine, Department of Pediatric Endocrinology and Diabetes, İstanbul, Turkey
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46
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Zorzetti N, Lauro A, Cuoghi M, La Gatta M, Marino IR, Sorrenti S, D’Andrea V, Mingoli A, Navarra GG. A Hypothetical New Challenging Use for Indocyanine Green Fluorescence during Laparoscopic Appendectomy: A Mini-Series of Our Experience and Literary Review. J Clin Med 2023; 12:5173. [PMID: 37629215 PMCID: PMC10455468 DOI: 10.3390/jcm12165173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Revised: 07/31/2023] [Accepted: 08/07/2023] [Indexed: 08/27/2023] Open
Abstract
Laparoscopic appendectomy (LA) is a well-standardized surgical procedure, but there are still controversies about the different devices to be used for the appendiceal stump closure and the related postoperative complications. Indocyanine green (ICG) fluorescence angiography (FA) has already been shown to be helpful in elective and emergency surgery, providing intraoperative information on tissue and organ perfusion, thus guiding the surgical decisions and the technical strategies. According to these two aspects, we report a mini-series of the first five patients affected by gangrenous and flegmonous acute appendicitis intraoperatively evaluated with ICG-FA during LA. The patients were admitted to the Emergency Department with an usual range of symptoms for acute appendicitis. The patients were successfully managed by fully LA with the help of a new hypothetical challenging use of ICG-FA.
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Affiliation(s)
- Noemi Zorzetti
- Department of General Surgery, “A. Costa” Hospital—Alto Reno Terme, 40046 Bologna, Italy (M.L.G.); (G.G.N.)
- Department of Surgical Sciences, La Sapienza University, 00186 Rome, Italy; (A.L.); (S.S.); (V.D.); (A.M.)
| | - Augusto Lauro
- Department of Surgical Sciences, La Sapienza University, 00186 Rome, Italy; (A.L.); (S.S.); (V.D.); (A.M.)
| | - Manuela Cuoghi
- Department of General Surgery, “A. Costa” Hospital—Alto Reno Terme, 40046 Bologna, Italy (M.L.G.); (G.G.N.)
| | - Marco La Gatta
- Department of General Surgery, “A. Costa” Hospital—Alto Reno Terme, 40046 Bologna, Italy (M.L.G.); (G.G.N.)
| | - Ignazio R. Marino
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA 19107, USA;
| | - Salvatore Sorrenti
- Department of Surgical Sciences, La Sapienza University, 00186 Rome, Italy; (A.L.); (S.S.); (V.D.); (A.M.)
| | - Vito D’Andrea
- Department of Surgical Sciences, La Sapienza University, 00186 Rome, Italy; (A.L.); (S.S.); (V.D.); (A.M.)
| | - Andrea Mingoli
- Department of Surgical Sciences, La Sapienza University, 00186 Rome, Italy; (A.L.); (S.S.); (V.D.); (A.M.)
| | - Giuseppe Giovanni Navarra
- Department of General Surgery, “A. Costa” Hospital—Alto Reno Terme, 40046 Bologna, Italy (M.L.G.); (G.G.N.)
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47
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Patel K, Varre JS, Williams N, Ruiz O. A case report of acute appendicitis complicated by pylephlebitis: medical and surgical management. J Surg Case Rep 2023; 2023:rjad495. [PMID: 37662446 PMCID: PMC10474561 DOI: 10.1093/jscr/rjad495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 08/15/2023] [Indexed: 09/05/2023] Open
Abstract
Pylephlebitis is a suppurative thrombus of the portal vein and/or its branches secondary to an intra-abdominal infection. Acute appendicitis is the most common cause of emergency operation in general surgery and is typically treated with antibiotics and timely appendectomy with minimal adverse outcomes (Ferris M, Quan S, Kaplan BS, et al. The global incidence of appendicitis: a systematic review of population-based studies. Ann Surg 2017;266:237-41 and Poon S, Lee J, NG KM, Chiu GWY, et al. The current management of acute uncomplicated appendicitis: should there be a change in paradigm? A systematic review of the literatures and analysis of treatment performance. WJES 2017;12:46). Unfortunately, the identification of pyelephlebitis is difficult to make due to its nonspecific clinical presentation and can result in significant morbidity or mortality if not appropriately treated. Certain laboratory derangements and positive intra-abdominal imaging combined with a high index of suspicion can make the diagnosis. Treatment involves broad-spectrum antibiotics, anticoagulation, and source control of the primary nidus of infection. Our case presentation follows the successful clinical course of a young male diagnosed with acute appendicitis complicated by pylephlebitis. He was treated with antibiotics and anticoagulation followed by interval laparoscopic appendectomy with consequential resolution of thrombus on subsequent cross-sectional imaging.
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Affiliation(s)
- Krishna Patel
- General Surgery, Riverside Methodist Hospital, Columbus, OH 43214, United States
| | - Jaya Sai Varre
- General Surgery, Riverside Methodist Hospital, Columbus, OH 43214, United States
| | - Nate Williams
- General Surgery, Riverside Methodist Hospital, Columbus, OH 43214, United States
| | - Oscar Ruiz
- General Surgery, Riverside Methodist Hospital, Columbus, OH 43214, United States
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48
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Çetinkaya E, Bayazıtlı ŞM, Göktaş A, Akın T, Akgül Ö, Er S, Hamamcı EO, Berkem H, Yüksel BC, Tez M. A new, simple marker for predicting complicated appendicitis in patients with normal white blood cell count indicator; LUC. ULUS TRAVMA ACIL CER 2023; 29:872-876. [PMID: 37563899 PMCID: PMC10560799 DOI: 10.14744/tjtes.2023.60196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Revised: 02/06/2023] [Accepted: 04/10/2023] [Indexed: 08/12/2023]
Abstract
BACKGROUND The aim of this study was to investigate the ability of a new marker that could be easily obtained to differentiate between complicated and uncomplicated appendicitis in a patients with a white blood cell (WBC) count within the normal range. METHODS The patients who underwent surgery with histopathologically proven acute appendicitis (AA) between January 2021 and October 2022 were evaluated retrospectively. Patients were classified into two groups as uncomplicated and complicated appendicitis, based on the surgical and histopathological findings. Groups were compared in terms of laboratory parameters at the time of hospital admission. RESULTS During the study period, 2589 patients underwent an appendectomy, among these 612 patients who had a WBC count within the normal range at the time of admission were analyzed. Uncomplicated appendicitis was detected in 79.6% of the patients and complicated appendicitis in 20.4%. Neutrophil%, neutrophil-to-lymphocyte ratio, C-reactive protein, and total bilirubin levels were significantly higher, whereas lymphocyte%, lymphocyte count, lymphocyte-to-monocyte ratio, sodium levels, and large unstained cells (LUC)% were significantly lower in patients with complicated appendicitis. Multiple logistic regression analysis revealed that lower LUC% (Odds Ratio [OR]: 0.45; 95% Confidence Intervals [CI]: 1.08-2.09; P=0.01) and higher total bilirubin levels (OR: 1.50; 95% CI: 1.08-2.09; P=0.01) were independent risk factors for complicated appendicitis. CONCLUSION In patients with a diagnosis of AA with a normal WBC value, LUC% obtained from the complete blood count can be used as a new parameter predicting the diagnosis of complicated appendicitis.
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Affiliation(s)
- Erdinç Çetinkaya
- Department of General Surgery, Ankara Bilkent City Hospital, University of Health Sciences, Ankara-Türkiye
| | - Şükrü Melih Bayazıtlı
- Department of General Surgery, Ankara Bilkent City Hospital, University of Health Sciences, Ankara-Türkiye
| | - Abidin Göktaş
- Department of General Surgery, Ankara Bilkent City Hospital, University of Health Sciences, Ankara-Türkiye
| | - Tezcan Akın
- Department of General Surgery, Ankara Bilkent City Hospital, University of Health Sciences, Ankara-Türkiye
| | - Özgür Akgül
- Department of General Surgery, Ankara Bilkent City Hospital, University of Health Sciences, Ankara-Türkiye
| | - Sadettin Er
- Department of General Surgery, Ankara Bilkent City Hospital, University of Health Sciences, Ankara-Türkiye
| | - Enver Okan Hamamcı
- Department of General Surgery, Ankara Bilkent City Hospital, University of Health Sciences, Ankara-Türkiye
| | - Hüseyin Berkem
- Department of General Surgery, Ankara Bilkent City Hospital, University of Health Sciences, Ankara-Türkiye
| | - Bülent Cavit Yüksel
- Department of General Surgery, Ankara Bilkent City Hospital, University of Health Sciences, Ankara-Türkiye
| | - Mesut Tez
- Department of General Surgery, Ankara Bilkent City Hospital, University of Health Sciences, Ankara-Türkiye
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49
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Nguyen HV, Tran LH, Ly TH, Pham QT, Pham VQ, Tran HN, Trinh LT, Dinh TT, Pham DT, Mai Phan TA. Impact of the COVID-19 Pandemic on the Severity and Early Postoperative Outcomes of Acute Appendicitis. Cureus 2023; 15:e42923. [PMID: 37546691 PMCID: PMC10400342 DOI: 10.7759/cureus.42923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/30/2023] [Indexed: 08/08/2023] Open
Abstract
Background The coronavirus disease 2019 (COVID-19) pandemic caused changes in surgical practice. For acute appendicitis (AA), measures to control the pandemic might hinder patients from seeking medical care timely, resulting in increasing severity, postoperative complications, and mortality. This study aimed to investigate whether the COVID-19 pandemic had a negative impact on the severity and postoperative outcomes of patients with AA. Methodology We retrospectively reviewed medical records of AA patients treated operatively at Nhan Dan Gia Dinh Hospital hospital from June 1st to September 30th in three consecutive years: pre-pandemic (2019)/Group 1, minor waves (2020)/Group 2, and major wave (2021)/Group 3 (2021). Data were collected focusing on the duration of symptoms, severity of AA, time from admission to operation, postoperative complications, and mortality. Results There were 1,055 patients, including 452 patients in Group 1, 409 in Group 2, and 194 in Group 3. The overall number of patients decreased mainly in non-complicated AA. The percentages of hospital admission after 24 hours gradually increased (20.8%, 27.9%, and 43.8%, p < 0.05). The percentages of complicated AA in Group 2 and Group 3 were statistically higher than in Group 1 (39% and 55% vs. 31%, p < 0.05). Waiting time for operation increased to five hours during the major wave. Laparoscopic appendectomy was performed in 98-99% of AA patients during the pandemic, with an early postoperative complication rate of 5-9% and a mortality rate of 0.2-1%. Conclusions Although the percentages of hospital admission after 24 hours and complicated AA increased, laparoscopic appendectomy was still feasible and effective and should be maintained as the standard management for AA during the COVID-19 pandemic.
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Affiliation(s)
- Hai V Nguyen
- Department of General Surgery, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, VNM
- Department of Digestive Surgery, Nhan Dan Gia Dinh Hospital, Ho Chi Minh City, VNM
| | - Loc H Tran
- Department of General Surgery, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, VNM
| | - Tuan H Ly
- Department of General Surgery, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, VNM
| | - Quang T Pham
- Department of General Surgery, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh, VNM
| | - Vu Q Pham
- Department of Digestive Surgery, Nhan Dan Gia Dinh Hospital, Ho Chi Minh City, VNM
| | - Ha N Tran
- Department of General Surgery, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, VNM
| | - Loc T Trinh
- Department of General Surgery, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, VNM
| | - Thien T Dinh
- Department of General Surgery, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, VNM
| | - Dinh T Pham
- Department of Digestive Surgery, Nhan Dan Gia Dinh Hospital, Ho Chi Minh City, VNM
| | - Tuong Anh Mai Phan
- Department of Digestive Surgery, Nhan Dan Gia Dinh Hospital, Ho Chi Minh City, VNM
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Dao D, Abdel-Raheem M, Lazim TR. A Spontaneous Heterotopic Pregnancy Presenting as Acute Appendicitis. Cureus 2023; 15:e42803. [PMID: 37664279 PMCID: PMC10470474 DOI: 10.7759/cureus.42803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/31/2023] [Indexed: 09/05/2023] Open
Abstract
Heterotopic pregnancy (HP) occurs when there is a simultaneous intrauterine and extrauterine pregnancy, either viable or non-viable. Although spontaneous HP is rare, it is important to consider this possibility. Acute appendicitis (AA) is a common non-obstetric surgical emergency in pregnant women. Diagnosing HP can be challenging, particularly in pregnant women who present with symptoms such as right iliac fossa pain and an acute abdomen. As HP may not be initially suspected in the presence of a viable intrauterine pregnancy, we present an intriguing case of spontaneous HP initially presenting as AA, along with a literature review. Our objective is to raise awareness of HP among trainee obstetricians and general surgeons.
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Affiliation(s)
- Dominique Dao
- General Surgery, Bronglais General Hospital, Aberystwyth, GBR
| | | | - Taha R Lazim
- General Surgery, Bronglais General Hospital, Aberystwyth, GBR
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