Diagnosis and treatment of appendicitis: systematic review and meta-analysis

Lamm, Ryan; Kumar, Sunjay S.; Collings, Amelia T.; Haskins, Ivy N.; Abou-Setta, Ahmed; Narula, Nisha; Nepal, Pramod; Hanna, Nader M.; Athanasiadis, Dimitrios I.; Scholz, Stefan; Bradley, Joel F.; Train, Arianne T.; Pucher, Philip H.; Quinteros, Francisco; Slater, Bethany

doi:10.1007/s00464-023-10456-5

Cited by 5 publications

(5 citation statements)

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“…Recently, the role of appendectomy as a generally unique valid standard for the treatment of suspected appendicitis has been frequently questioned. In addition to standard operative intervention, conservative therapy has been the subject of a considerable number of studies in adults and, increasingly, children [ 3 , 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 ]. Current studies have demonstrated comparable outcomes between nonoperative therapy with antibiotics and the operative approach for uncomplicated appendicitis in children [ 6 , 12 ]; however, for conservative management, the recurrence rate after one year is approximately 32% [ 9 ].…”

Section: Introductionmentioning

confidence: 99%

Suspected Simple Appendicitis in Children: Should We Use a Nonoperative, Antibiotic-Free Approach? An Observational Study

Reis Wolfertstetter,

Ebert,

Barop

et al. 2024

Children

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Background: Simple appendicitis may be self-limiting or require antibiotic treatment or appendectomy. The aim of this study was to assess the feasibility and safety of a nonoperative, antibiotic-free approach for suspected simple appendicitis in children. Methods: This single-center, retrospective study included patients (0–17 years old) who were hospitalized at the pediatric surgery department due to suspected appendicitis between 2011 and 2012. Data from patients who primarily underwent appendectomy were used as controls. The follow-up of nonoperatively managed patients was conducted in 2014. The main outcome of interest was appendicitis recurrence. Results: A total of 365 patients were included: 226 were treated conservatively and 139 underwent appendectomy. Fourteen (6.2% of 226) of the primarily nonoperatively treated patients required secondary appendectomy during follow-up, and histology confirmed simple, uncomplicated appendicitis in 10 (4.4% of 226) patients. Among a subset of 53 patients managed nonoperatively with available Alvarado and/or Pediatric Appendicitis Scores and sonographic appendix diameters in clinical reports, 29 met the criteria for a high probability of appendicitis. Three of these patients (10.3% of 29) underwent secondary appendectomy. No complications were reported during follow-up. Conclusions: A conservative, antibiotic-free approach may be considered for pediatric patients with suspected uncomplicated appendicitis in a hospital setting. Only between 6 and 10% of these patients required secondary appendectomy. Nevertheless, the cohort of patients treated nonoperatively was likely to have also included individuals with further abdominal conditions other than appendicitis. Active observation and clinical support during the disease course may help patients avoid unnecessary procedures and contribute to spontaneous resolution of appendicitis or other pediatric conditions as the cause of abdominal pain. However, further studies are needed to define validated diagnostic and management criteria.

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Section: Introductionmentioning

confidence: 99%

Suspected Simple Appendicitis in Children: Should We Use a Nonoperative, Antibiotic-Free Approach? An Observational Study

Reis Wolfertstetter,

Ebert,

Barop

et al. 2024

Children

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“…[4] Diagnosis of appendicitis typically involves physical examination, symptom inquiry, blood tests, and imaging studies. [5] Upon confirmation of diagnosis, surgical treatment is usually undertaken. Surgery is often performed as soon as inflammation is detected to prevent appendiceal rupture and spread of infection.…”

Section: Introductionmentioning

confidence: 99%

Mining and exploration of appendicitis nursing targets: An observational study

Mi,

Kang,

Hou

et al. 2024

Medicine

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Appendicitis is an inflammation caused by obstruction of the appendiceal lumen or termination of blood supply leading to appendiceal necrosis followed by secondary bacterial infection. The relationship between TYROBP gene and the nursing of appendicitis remains unclear. The appendicitis dataset GSE9579 profile was downloaded from the gene expression omnibus database generated from GPL571. Differentially expressed genes were screened, followed by weighted gene co-expression network analysis, functional enrichment analysis, gene set enrichment analysis, construction and analysis of protein–protein interaction network, Comparative Toxicogenomics Database analysis, and immune infiltration analysis. Heatmaps of gene expression levels were plotted. A total of 1570 differentially expressed genes were identified. According to gene ontology analysis, they were mainly enriched in organic acid metabolic process, condensed chromosome kinetochore, oxidoreductase activity. In Kyoto Encyclopedia of Gene and Genome analysis, they mainly concentrated in metabolic pathways, P53 signaling pathway, PPAR signaling pathway. The soft threshold power in weighted gene co-expression network analysis was set to 12. Through the construction and analysis of protein–protein interaction network, 5 core genes (FCGR2A, IL1B, ITGAM, TLR2, TYROBP) were obtained. Heatmap of core gene expression levels revealed high expression of TYROBP in appendicitis samples. Comparative Toxicogenomics Database analysis found that core genes (FCGR2A, IL1B, ITGAM, TLR2, TYROBP) were closely related to abdominal pain, gastrointestinal dysfunction, fever, and inflammation occurrence. TYROBP gene is highly expressed in appendicitis, and higher expression of TYROBP gene indicates worse prognosis. TYROBP may serve as a molecular target for appendicitis and its nursing.

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“…10 Computed tomography (CT) yields a high sensitivity (>80%) and specificity (>93%) in adults, but it does show significant variability in children; in addition, CT involves exposing children to ionizing radiation. 1 Magnetic resonance imaging (MRI) avoids radiation exposure and shows similar accuracy to CT; nevertheless, its use is limited by cost, availability, and the need for sedation or general anesthesia in young children. 11 Therefore, a test that allows an accurate preoperative diagnosis of acute appendicitis, and ideally differentiation between SA and PA, is highly desirable, allowing improved counseling and a tailored approach to individual patient management.…”

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confidence: 99%

“…However, its accuracy is variable, being highly operator dependent, although the presence of specific sonographic signs can aid diagnosis and differentiation between SA and PA in children . Computed tomography (CT) yields a high sensitivity (>80%) and specificity (>93%) in adults, but it does show significant variability in children; in addition, CT involves exposing children to ionizing radiation . Magnetic resonance imaging (MRI) avoids radiation exposure and shows similar accuracy to CT; nevertheless, its use is limited by cost, availability, and the need for sedation or general anesthesia in young children …”

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confidence: 99%

“…

Acute appendicitis is the most common surgical emergency in children, with a lifetime risk estimated between 2% and 9%. 1 It can be classified as simple appendicitis (SA) or perforated appendicitis (PA), also referred to as complicated appendicitis; clinically, the latter is defined in the presence of macroscopic perforation and/or 4-quadrant pus and/or intra-abdominal mass/ abscess or free fecalith. 2 Although the mortality risk for SA is reported as low as 0.1%, PA has a 5% mortality risk, highlighting the need for timely and accurate diagnosis and treatment.

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confidence: 99%

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New Genetic Biomarkers to Diagnose Pediatric Appendicitis

Pacilli,

Kamaleswaran

2024

JAMA Pediatr

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Diagnosis and treatment of appendicitis: systematic review and meta-analysis

Cited by 5 publications

References 254 publications

Suspected Simple Appendicitis in Children: Should We Use a Nonoperative, Antibiotic-Free Approach? An Observational Study

Suspected Simple Appendicitis in Children: Should We Use a Nonoperative, Antibiotic-Free Approach? An Observational Study

Mining and exploration of appendicitis nursing targets: An observational study

New Genetic Biomarkers to Diagnose Pediatric Appendicitis

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