Complicated Appendicitis: A Surgical Controversy Concerning Risk Factors, Diagnostic Algorithm and Therapeutic Management

Mekakas, Athanasios; Nagorni, Eleni‐Aikaterini; Tablaridis, Theodoros

doi:10.5772/intechopen.97270

Cited by 8 publications

(15 citation statements)

References 57 publications

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“…Many studies have reported that an increase in WBC count has been the earliest sign of appendiceal inflammation, while increased C-reactive protein has been noted in more advanced stages of appendicitis. 20 Despite this, and the same as our study, the elevation of WBC was found to be significantly associated with CA in many other studies. [22][23][24] The results of the importance of the preoperative interval as a predictor of CA are inconsistent.…”

supporting

confidence: 51%

“…The pain usually localizes to the RLQ if the perforation has been walled off by regional intra-abdominal structures, but can be diffuse if generalized peritonitis occurs. 20 According to our study, respondents who had generalized abdominal tenderness and who were clinically diagnosed to have peritonitis were more likely to have CA than their counterparts. Generalized abdominal tenderness may have occurred as a result of peritonitis, which is one of the complications of perforated appendicitis.…”

Section: Discussionmentioning

confidence: 61%

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Characteristics of Patients Presented with Complicated Appendicitis in Adama, Ethiopia: A Cross-Sectional Study

Dagne¹,

Abebaw²

2022

OAEM

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Background Complicated appendicitis (CA) is defined as perforated appendicitis, peritonitis, peri-appendicular abscess, or appendicular mass. One-third of patients who develop appendicitis are diagnosed with CA at presentation. Studies regarding the prevalence of CA are lacking in low-income countries, and the characteristics of patients presented with CA are incoherently identified. Objective To assess the prevalence and the significant characteristics associated with CA among patients admitted with the diagnosis of acute appendicitis at Adama Hospital Medical College. Methods A cross-sectional study was conducted from January 1, 2018, up to December 31, 2019. From a total of 1043 patients during the study period, the charts of 431 patients were selected using a systematic random sampling technique. Data were collected by a structured checklist. Bivariate and multivariable binary logistic regression analyses were employed to assess the association of patients’ characteristics with CA. Results Out of 431 patients, 157 (36.4%) had CA. Characteristics of patients having a significant association with CA were found to be generalized abdominal tenderness (AOR: 27.48, 95% CI: 4.03, 187.24), diagnosis with peritonitis (AOR: 14.87, 95% CI: 4.05, 54.54), right lower quadrant (RLQ) abdominal mass (AOR: 7.79, 95% CI: 2.02, 29.99), shock (10.37, 95% CI: 3.18, 33.76), white blood cell (WBC) count >11,000 (AOR: 2.16, 95% CI: 1.02, 4.61), onset to visit interval of 8–14 days (AOR: 10.45, 95% CI: 2.4, 45.52) and ultrasound report of acute appendicitis (AOR: 0.33, 95% CI: 0.13, 0.85), appendiceal abscess (AOR: 5.05, 95% CI: 1.48, 17.31), and appendiceal mass (AOR: 6.04, 95% CI: 1.45, 25.14). Conclusion The prevalence of CA was very high. Generalized abdominal tenderness, RLQ abdominal mass, shock, WBC count, onset to visit interval, abdominopelvic ultrasound report, and clinical diagnosis of peritonitis were significantly associated with CA.

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supporting

confidence: 51%

Section: Discussionmentioning

confidence: 61%

Characteristics of Patients Presented with Complicated Appendicitis in Adama, Ethiopia: A Cross-Sectional Study

Dagne¹,

Abebaw²

2022

OAEM

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“…13 Stitch line inflammatory alterations were present in 6.67% of patients in group A and 10.00% of patients in group B, with a p value of negligible 15 . Fever was seen in 13.3% of patients in group A and 10.0% of patients in group B; their p values are both1 10,14 . Hence, we can draw the conclusion that post-operative antibiotics have no effect on the prevention of post-operative problems and that carefully chosen and well timed pre-operative antibiotics are sufficient 16,17…”

Section: Discussionmentioning

confidence: 90%

Comparative Role of Different Antibiotics for Non‐Perforated Acute Appendicitis a Meta-Base Histopathological Study

Shahabuddin¹,

Umar²,

Hameed³

et al. 2023

PJMHS

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Background: The preferred method of treating appendicitis for more than a century has been appendectomy. Recent trials have challenged this theory. In patients with non-perforated appendicitis, this study evaluated the advantages and disadvantages of antibiotic treatment against appendectomy. Aims and objectives: Surgery vs. non-operative antibiotic treatment for acute non-perforated appendicitis. Study design: A meta-base histopathological study. Methodology: By using inclusion and exclusion criteria, all matched patients were chosen for the study and divided into two groups, group A and group B, using the closed envelop technique. All patients received an injection of injectable ceftriaxone 1 g and metronidazole 500 mg as part of an antibiotic prophylaxis regimen prior to surgery, while group A, patients received a single dosage of the same medications. Intravenous and oral antibiotic regimens, a second- or third-generation cephalosporin or ceftriaxone plus metronidazole injectable. The statistical software for the social science system (SPSS) version 17.0 was used for the statistical analysis. A (p≤0.05) value was used to denote a significant difference for all statistical tests. Antibiotics: Intravenous and oral antibiotic regimens (i) A second- or third-generation cephalosporin, or ceftriaxone plus metronidazole injectable (ii) single-agent regimens of amoxicillin-clavulanate. (iii) Fluoroquinolone or an advanced generation cephalosporin plus metronidazole, and amoxicillin-clavulanate. Practical Implications: In patients with non-perforated appendicitis, this study evaluated the advantages and disadvantages of antibiotic treatment against appendicectomy. In patients with clinically uncomplicated appendicitis, the decision between medicinal and surgical care is value and preference-dependent, indicating the need for a shift in practice towards collaborative decision-making. Results: Seroma was present in (12±0.01) of patients in group A and (20±0.02) of patients in group B; the (p≤0.05) value is very higher than Group-A, which is statistically insignificant. That implies that post-operative antibiotic medication does not lessen seroma development. In table-2 intra-abdominal abscess formation levels in group-A and Group- B were (7.2±0.02, 15±0.02) which indicated that antibacterial postoperative therapy was not effective as pre past- operative. That implies that antibacterial postoperative therapy does not lessen local site edema. People in both groups (16.2±0.01, 19±0.02) experienced pus discharge from the stitch line, and the p value is uncertain. Fever was seen in (6.5±0.01) of patients in group A and (10.2±0.02) of patients in group B; their p values were (P≤0.01 and P≤0.02) occasionally. Patients' length of hospital stays were shown that pre and post-surgery treatment was statistically significant than only post-surgery treatment. Conclusion: As a result, we can draw the conclusion from our study that, in cases of non-perforated appendicitis, carefully chosen and appropriately timed pre-operative antibiotics are sufficient in preventing Seroma formation, Intra-abdominal abscess formation, Local site edema, pus discharge from the stitch line, fever and stay in hospital. Post-operative antibiotics were not affect the rate of occurrence of the above mentioned variables. Keywords: Seroma formation, Intra-abdominal abscess formation, Local site edema, Pus discharge from the stitch line, Antibiotics. Appendicitis.

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“…6,7 In the past, patients presenting with appendicitis and a significant phlegmon or an associated appendicular abscess were treated surgically, often necessitating partial colon and/or small bowel resection due to the significant inflammation and technical difficulty. 8 Nowadays, management of stable, non-diffusely peritonitic patients, presenting with complicated appendicitis and a peri-appendicular abscess, includes antibacterial treatment, percutaneous drainage, and a close clinical and radiologic follow-up, that will eventually determine if the patient will necessitate an interval appendectomy. 9,10 The decision-making process for an elective appendectomy is decided based on a variety of clinical and radiologic factors, including patient symptomatology, patient preference and resolution or non-resolution of the peri-appendicular abscess on imaging.…”

Section: Introductionmentioning

confidence: 99%

Ultrasound-Tomographic Image Fusion – A Novel Tool for Follow up After Acute Complicated Appendicitis

et al. 2023

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Background Computerized tomography (CT) is an integral part of the follow-up and decision-making process in complicated acute appendicitis (AA) treated non-operatively. However, repeated CT scans are costly and cause radiation exposure. Ultrasound-tomographic image fusion is a novel tool that integrates CT images to an Ultrasound (US) machine, thus allowing accurate assessment of the healing process compared to CT on presentation. In this study, we aimed to assess the feasibility of US-CT fusion as part of the management of appendicitis. Materials and Methods We retrospectively collected data of consecutive patients with complicated AA managed non-operatively and followed up with US Fusion for clinical decision-making. Patients demographics, clinical data, and follow-up outcomes were extracted and analyzed. Results Overall, 19 patients were included. An index Fusion US was conducted in 13 patients (68.4%) during admission, while the rest were performed as part of an ambulatory follow-up. Nine patients (47.3%) had more than 1 US Fusion performed as part of their follow-up, and 3 patients underwent a third US Fusion. Eventually, 5 patients (26.3%) underwent elective interval appendectomy based on the outcomes of the US Fusion, due to a non-resolution of imaging findings and ongoing symptoms. In 10 patients (52.6%), there was no evidence of an abscess in the repeated US Fusion, while in 3 patients (15.8%), it significantly diminished to less than 1 cm in diameter. Conclusion Ultrasound-tomographic image fusion is feasible and can play a significant role in the decision-making process for the management of complicated AA.

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Complicated Appendicitis: A Surgical Controversy Concerning Risk Factors, Diagnostic Algorithm and Therapeutic Management

Cited by 8 publications

References 57 publications

Characteristics of Patients Presented with Complicated Appendicitis in Adama, Ethiopia: A Cross-Sectional Study

Characteristics of Patients Presented with Complicated Appendicitis in Adama, Ethiopia: A Cross-Sectional Study

Comparative Role of Different Antibiotics for Non‐Perforated Acute Appendicitis a Meta-Base Histopathological Study

Ultrasound-Tomographic Image Fusion – A Novel Tool for Follow up After Acute Complicated Appendicitis

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