Conservative treatment in uncomplicated acute appendicitis: reassessment of practice safety

Steiner, Zvi; Buklan, Genady; Stackievicz, Rodica; Gutermacher, Michael; Litmanovitz, Ita; Golani, Guy; Arnon, Shmuel

doi:10.1007/s00431-017-2867-2

Cited by 27 publications

(25 citation statements)

References 22 publications

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“…We hope to be able to add more information on ultrasound findings, for instance appendiceal intraluminal fluid in ultrasound examinations as this feature was considered important for differentiating between AUA and ACA. 15…”

Section: Discussionmentioning

confidence: 99%

“…[7][8][9] However, recent and upcoming paediatric studies have confirmed or the aim to support that nonoperative management with antibiotics is a feasible and safe option for patients with acute uncomplicated phlegmonous appendicitis while appendicectomy remains the appropriate treatment for acute complicated appendicitis defined by gangrene or perforation. [10][11][12][13][14][15] Of note, conservative treatment leads to symptom relief just after one day and thus is not inferior to appendicectomy concerning this matter. 16 Therefore, the use of ultrasound for the pre-operative differentiation between gangrenous/perforated appendicitis and uncomplicated appendicitis is important, especially in regard of defining treatment groups.…”

Section: Introductionmentioning

confidence: 99%

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Sonographic differentiation of complicated from uncomplicated appendicitis

Rawolle

Reismann

Minderjahn

et al. 2019

The British Journal of Radiology

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Objective: This study aims to differentiate acute uncomplicated and complicated appendicitis, by investigating the correlation between sonographic findings and histological results in different types of paediatric appendicitis. Methods: This is a retrospective study of 1017 paediatric patients (age < 18 years) who underwent ultrasound by paediatric radiologists before appendicectomy at our institution between 2006 and 2016. Histologically, uncomplicated appendicitis was primarily associated with transmural infiltration of neutrophil granulocytes, while complicated appendicitis was characterised by transmural myonecrosis. Logistic regression analyses were used to investigate the association between sonographic and histological findings. Results: Out of 566 (56%) male and 451 (44%) female patients with a mean age of 10.7 years, uncomplicated appendicitis was histologically diagnosed in 446 (44%) children and complicated appendicitis was diagnosed in 348 (34%) cases. The following ultrasound findings were significantly associated with complicated appendicitis in multivariate regression: an increased appendiceal diameter (OR = 1.3, p < .001), periappendiceal fat inflammation (OR = 1.5, p = 0.02), the presence of an appendicolith (OR = 1.7, p = 0.01) and a suspected perforation (OR = 6.0, p < .001) by the pediatric radiologist. For complicated appendicitis, an appendiceal diameter of more than 6 mm had the highest sensitivity (98%), while a sonographically suspected perforation showed the highest specificity (94%). Conclusion: Abdominal sonography by paediatric radiologists can differentiate between uncomplicated and complicated appendicitis in paediatric patients by using an increased appendiceal diameter, periappendiceal fat inflammation, the presence of an appendicolith and a suspected perforation as discriminatory markers. Advances in knowledge: This paper demonstrates expanded information on ultrasound, which is not only an essential tool for diagnosing appendicitis, but also a key method for distinguishing between different forms of appendicitis when performed by paediatric radiologists. Compared with previous studies, the crucial distinction features in our analysis are 1) the definition of gangrene and not primarily perforation as an acute complicated appendicitis enabling early decision-making by sonography and 2) a large number of patients in a particularly affected age group.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Sonographic differentiation of complicated from uncomplicated appendicitis

Rawolle

Reismann

Minderjahn

et al. 2019

The British Journal of Radiology

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“…Appendicolith is a known risk-factor for non-operative treatment of appendicitis [ 20 , 36 , 37 ], and its surgical treatment is recommended [ 38 ]. Before conducting this study, the authors did not expect that appendicolith was also a risk-factor in surgical treatment of appendicitis; therefore, they did not manage patients with appendicolith specifically.…”

Section: Discussionmentioning

confidence: 99%

Should ambulatory appendectomy become the standard treatment for acute appendicitis?

Gignoux¹,

Blanchet²,

Lanz³

et al. 2018

World J Emerg Surg

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BackgroundAppendectomy is increasingly performed as a ‘short stay’ or ‘ambulatory’ procedure, yet there is no consensus for selection of patients with acute appendicitis for ambulatory surgery (AS). We aimed to compare characteristics and outcomes of complicated and uncomplicated appendectomies performed in ambulatory vs. conventional settings, and to determine factors associated with unexpected re-consultations and re-hospitalizations.MethodsThe authors reviewed a consecutive series of 185 laparoscopic appendectomies. Whenever possible, patients were offered AS, defined as ‘discharge on the same working day.’ Multivariable regressions were performed to determine associations of unexpected re-consultations and re-hospitalizations with surgery type (ambulatory or conventional) and patient characteristics (age, gender, obesity, symptoms, appendicolith, perforations, appendix diameter, serologic results, American Society of Anesthesiologists score, and Saint-Antoine score).ResultsFrom the initial cohort, 117 patients (63.2%) were eligible for AS, of which 8 had peri- or post-operative contraindications. Therefore, 109 patients (58.9%) were operated by AS, with median length of stay 8.5 h (range, 3.3–20.5). Ambulatory cases had a lower incidence of complications (11.9%) than conventional cases (25.0%) (p = 0.029). Uni- and multi-variable regressions revealed that unexpected re-consultations were not significantly associated with any of the pre- or peri-operative variables but that unexpected re-hospitalizations were 4 times more likely for patients with appendicolith (OR, 4.32; p = 0.04).ConclusionsAmbulatory surgery could be considered as a standard procedure for both complicated and uncomplicated acute appendicitis. Appendicolith was found to be an independent risk factor for unexpected re-hospitalization and should therefore trigger closer monitoring.

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“…Non-operative method seems to be effective in management of acute uncomplicated appendicitis. [3][4][5][6][7] Accurate selection of patients whose appendix inflammation could be controlled by the use of antibiotics may improve the success rate of nonsurgical treatment.…”

Section: Introductionmentioning

confidence: 99%

Appendicolith: an explicit factor leading to complicated appendicitis in childhood

et al. 2020

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Objectives. This study aims to assess the clinical risk of pediatric appendicitis with appendicolith and its guiding significance in therapeutic strategies' selection. Methods. Children diagnosed with acute appendicitis from June 2011-January 2017 were analyzed retrospectively. Patient cohort was divided to appendicolith group (AG) and nonappendicolith group (NAG) based on whether the appendicolith presents or not in the open surgery. Clinical presentations, laboratory parameters, computed tomography findings, and pathological changes were reviewed and compared between two groups. Results. Among 163 patients, 23 (mean age, 6.1 years old) were defined in AG and 140; mean age, 8.1 years old) in NAG. The patients in AG demonstrated prolonged length of stay (12.4 ± 5.6d vs. 8.

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Conservative treatment in uncomplicated acute appendicitis: reassessment of practice safety

Cited by 27 publications

References 22 publications

Sonographic differentiation of complicated from uncomplicated appendicitis

Sonographic differentiation of complicated from uncomplicated appendicitis

Should ambulatory appendectomy become the standard treatment for acute appendicitis?

Appendicolith: an explicit factor leading to complicated appendicitis in childhood

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