Acute Appendicitis Review: Background, Epidemiology, Diagnosis, and Treatment

Krzyzak, Michael; Mulrooney, Stephen

doi:10.7759/cureus.8562

Cited by 71 publications

(112 citation statements)

References 42 publications

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“…Acute appendicitis is a common acute inflammatory disease affecting the appendix, a hollow organ located at the tip of the cecum 1 – 3 . Obstruction of the appendiceal orifice caused by infection, lymphoid hyperplasia, fecaliths or tumor (either benign or malignant) is thought to be the likely pathophysiology leading to the acute inflammation of appendix 1 .…”

Section: Introductionmentioning

confidence: 99%

“…In the USA, acute appendicitis mostly occurs in youngsters aged 10–20 years with a sex ratio of male-to-female of 1.4 and the estimated lifetime risk of acute appendicitis in men was 8.6% and in women was 6.7% 2 . Appendectomy by surgical operation is a standard treatment, but treatment with antibiotics or endoscopic retrograde appendicitis therapy can be used in selected patients 3 .…”

Section: Introductionmentioning

confidence: 99%

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Metformin use is associated with a reduced risk of acute appendicitis in Taiwanese patients with type 2 diabetes mellitus

Tseng

2021

Sci Rep

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This retrospective cohort study used the nationwide database of Taiwan’s National Health Insurance to investigate whether metformin would reduce the risk of acute appendicitis in patients with type 2 diabetes mellitus. We first identified 423,949 patients newly diagnosed of diabetes from 1999 to 2005. After excluding patients having type 1 diabetes mellitus, missing data, previous history of acute appendicitis, aged < 15 years, aged > 80 years and followed up for < 6 months, 338,172 ever users and 21,861 never users of metformin were followed up from January 1, 2006 until December 31, 2011. Incidence of acute appendicitis was estimated for never users, ever users and subgroups (divided by median, tertiles and quartiles, respectively) of dose–response indicators including cumulative duration (months), cumulative dose (mg) and average daily dose (mg/day) of metformin therapy. We used Cox regression incorporated with the inverse probability of treatment weighting using propensity score to estimate the overall hazard ratio for ever versus never users, and the hazard ratios for subgroups of dose–response indicators versus never users. Results showed that new-onset acute appendicitis was diagnosed in 1558 ever users and 179 never users during follow-up. The incidence was 98.15 per 100,000 person-years in ever users and was 189.48 per 100,000 person-years in never users. The overall hazard ratio (95% confidence interval) of 0.514 (0.441–0.600) suggested a lower risk of acute appendicitis associated with metformin use. A dose–response pattern was consistently observed in the analyses of different subgroups of dose–response indicators and the reduced risk associated with metformin use was consistently observed in various sensitivity analyses. An average daily dose of 1000–1500 mg/day can significantly reduce the risk by > 50%. The benefit did not differ between different formulations of metformin, and the estimated hazard ratio for conventional/immediate-release metformin versus never users was 0.516 (0.441–0.603) and was 0.509 (0.421–0.615) for prolonged/slow-release metformin versus never users. It is concluded that metformin use is associated with a reduced risk of acute appendicitis in patients with type 2 diabetes mellitus.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Metformin use is associated with a reduced risk of acute appendicitis in Taiwanese patients with type 2 diabetes mellitus

Tseng

2021

Sci Rep

View full text Add to dashboard Cite

show abstract

Section: Introductionmentioning

confidence: 99%

“…Appendicitis is an abdominal pathology with an overall lifetime risk of 8.6% in males and 6.7% in females [1] , [2] , [3] , [4] . Commonly occurring in children and young adults, the etiology of acute appendicitis is luminal obstruction from fecaliths or lymphoid hyperplasia [1 , 2 , 5] . When occurring in older patient populations, appendicitis is rarely seen secondary to an underlying neoplastic luminal obstruction [1] , [2] , [3] , 5 , 6] .…”

Section: Introductionmentioning

confidence: 99%

“…Commonly occurring in children and young adults, the etiology of acute appendicitis is luminal obstruction from fecaliths or lymphoid hyperplasia [1 , 2 , 5] . When occurring in older patient populations, appendicitis is rarely seen secondary to an underlying neoplastic luminal obstruction [1] , [2] , [3] , 5 , 6] . Neoplastic changes may be identified on initial CT evaluation performed for appendicitis if there is concurrent presence of a large mass, invasion of intestinal mucosa, presence of enlarged lymph nodes, or evidence of metastatic proliferation.…”

Section: Introductionmentioning

confidence: 99%

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Metastatic Cecal Adenocarcinoma presenting as acute appendicitis

Shroff

Bhargava

2021

Radiology Case Reports

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This case report details the findings of metastatic colon cancer in an older male patient who initially presented with signs and symptoms of acute appendicitis. The patient underwent routine CT (Computed Tomography) imaging for diagnostic evaluation of appendicitis. Subsequently, the patient was found to have findings consistent with acute appendicitis secondary to obstruction from a cecal mass with evidence of hepatic and pulmonary metastases. This case report demonstrates the radiological findings of acute appendicitis secondary to metastatic colorectal disease and highlights the importance of considering underlying malignancy in cases of appendicitis occurring in older individuals.

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Diagnosis and Management of Acute Appendicitis in Adults

Moris

Paulson

Pappas

2021

JAMA

153

113

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ppendicitis is defined as inflammation of the vermiform appendix and worldwide is the most common reason for emergency abdominal surgery. Globally, the annual incidence is 96.5 to 100 cases per 100 000 adult population. 1,2 The diagnosis of acute appendicitis is based on history and physical, laboratory evaluation, and imaging. With these diagnostic methods, early and accurate diagnosis of acute appendicitis can be typically achieved in an estimated more than 90% of patients, 3 including in premenopausal women, for whom gynecologic pathologies can mimic appendicitis, and in older patients, for whom appendicitis can present with nonclassical clinical features (ie, generalized instead of localized abdominal pain, lack of leukocytosis). 4 Open appendectomy has been standard treatment for appendicitis since 1735. 5 Over the past 40 years, laparoscopy gradually became the routine surgical treatment. Compared with an open approach, laparoscopic appendectomy is associated with less postoperative pain and faster recovery, earlier hospital discharge, and faster return to normal state of health. [6][7][8] Recent clinical trials have suggested that it is feasible and effective to treat acute uncomplicated appendicitis nonoperatively with antibiotics alone. [9][10][11][12][13][14][15] This review summarizes current evidence regarding diagnosis and management of acute appendicitis in adults. Discussions and Observations MethodsThe MEDLINE/PubMed, Scopus, Cochrane, and EMBASE databases were searched for English-language studies on the diagnosis IMPORTANCE Acute appendicitis is the most common abdominal surgical emergency in the world, with an annual incidence of 96.5 to 100 cases per 100 000 adults.OBSERVATIONS The clinical diagnosis of acute appendicitis is based on history and physical, laboratory evaluation, and imaging. Classic symptoms of appendicitis include vague periumbilical pain, anorexia/nausea/intermittent vomiting, migration of pain to the right lower quadrant, and low-grade fever. The diagnosis of acute appendicitis is made in approximately 90% of patients presenting with these symptoms. Laparoscopic appendectomy remains the most common treatment. However, increasing evidence suggests that broad-spectrum antibiotics, such as piperacillin-tazobactam monotherapy or combination therapy with either cephalosporins or fluroquinolones with metronidazole, successfully treats uncomplicated acute appendicitis in approximately 70% of patients. Specific imaging findings on computed tomography (CT), such as appendiceal dilatation (appendiceal diameter Ն7 mm), or presence of appendicoliths, defined as the conglomeration of feces in the appendiceal lumen, identify patients for whom an antibiotics-first management strategy is more likely to fail. CT findings of appendicolith, mass effect, and a dilated appendix greater than 13 mm are associated with higher risk of treatment failure (≈40%) of an antibiotics-first approach. Therefore, surgical management should be recommended in patients with CT findings of appendicolith, mass eff...

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Acute Appendicitis Review: Background, Epidemiology, Diagnosis, and Treatment

Cited by 71 publications

References 42 publications

Metformin use is associated with a reduced risk of acute appendicitis in Taiwanese patients with type 2 diabetes mellitus

Metformin use is associated with a reduced risk of acute appendicitis in Taiwanese patients with type 2 diabetes mellitus

Metastatic Cecal Adenocarcinoma presenting as acute appendicitis

Diagnosis and Management of Acute Appendicitis in Adults

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