Is Emergency Appendicectomy Better Than Elective Appendicectomy for the Treatment of Appendiceal Phlegmon?: A Review

Ahmed, Asma; Feroz, Shah Huzaifa; Dominic, Jerry Lorren; Muralidharan, Abilash; Thirunavukarasu, Pragatheeshwar

doi:10.7759/cureus.12045

Cited by 10 publications

(8 citation statements)

References 26 publications

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“…Lately [ 21 ], the previous undisputed concept of conservatively treating an appendiceal abscess has been questioned, at least among adult patients. In the laparoscopic era an emergency appendectomy is considered a quick, safe and feasible treatment for appendiceal abscess.…”

Section: Discussionmentioning

confidence: 99%

The Histopathology of the Appendix in Children at Interval Appendectomy

et al. 2021

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Whilst most surgeons agree that conservative treatment of appendiceal abscess in children is an adequate treatment, the need for subsequent interval appendectomy is still controversial. We analyzed the histopathology in interval appendectomy in search of signs of inflammation. All patients admitted between 2010 and 2017 with appendiceal abscess and scheduled for interval appendectomy were reviewed. The specimens were evaluated for grade of inflammation, type and distribution of cellular infiltrate, presence of necrosis or hemorrhage and infiltrate in the serosa. Forty-two patients had appendiceal abscess and were treated conservatively. Seven underwent emergent appendectomy. Thirty-three out of 35 patients underwent elective interval appendectomy. Thirty-two specimens were revised. Carcinoid tumor or other malignant lesions were not found. All of them presented some amount of inflammation, grade 1 to 2 in 53%, grade 3 to 4 in 47%. Twenty-five percent of the specimens had signs of necrosis accompanied by hemorrhage and in more than the half (53%) the infiltrate extended to the serosa. Conclusions: Although the appendix was mostly found not macroscopically inflamed intraoperatively, histology confirmed a certain grade of inflammation even months after the conservative treatment. No correlation was found between histopathologic findings and lapse of time between abscess treatment and interval appendectomy.

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Section: Discussionmentioning

confidence: 99%

The Histopathology of the Appendix in Children at Interval Appendectomy

et al. 2021

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“…The majority of them were classi ed as grade I and II (ileus and super cial surgical site infection) according to Clavien-Dindo's classi cation, as found in our patients (19). Ahmed et al (20) suggest that there must be a strict following process for patients in order to exclude the presence of hidden pathologies like colitis and even malignancies, especially in elderly patients (20,21). Nonetheless, in our population, no appendiceal, colonic neoplasms, or any other hidden pathologies were documented in pathology reports.…”

Section: Discussionmentioning

confidence: 60%

Appendiceal Phlegmon as an intraoperative finding: A retrospective analysis

Conde¹,

Rodríguez

Venegas

et al. 2023

Preprint

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Background Emergency procedures due to acute surgical abdomen correspond to a great part of emergency surgeries. Appendicitis is the most common abdominal surgical emergency in the world. Intraoperative findings can represent a challenging scenario for the surgical team and its decisions. Appendiceal phlegmon/plastron presents in 3.8-7% of patients with appendicitis and can be considered as a challenging surgical scenario where expertise may gain a fundamental value in terms of decision-making process. Therefore, we present clinical courses and outcomes of 40 patients that underwent emergency surgery with these intraoperative findings from 2016 to 2018. Methods Retrospective study with a prospective database in which we described patients with emergent need for surgical procedure due to peritoneal signs with surgical findings of appendiceal phlegmon. Multivariate analysis was performed to prove the relationship between obesity, diabetes, and surgeon experience with any complication and colonic resection. Results 40 patients underwent surgical procedure due to peritoneal signs with intraoperative findings of appendiceal phlegmon. Mean age was 51.9 (± 20.4). Procedures were performed based on intraoperative findings being appendectomy the most frequent (85%), followed by right hemicolectomy (10%) and partial cecum resection (5%). Three patients required reintervention. No mortalities were documented. Surgeries performed by junior surgeons have a higher probability to require colonic resections (P = 0.05, OR 4.05 ,95% CI), also obesity is associated with complications (P = 0.04, OR 1.44, 95% CI). Conclusion Finding of appendiceal phlegmon constitute a challenging surgical scenario in daily practice. Our patient’s complication rates are similar to those described in literature despite its emergent circumstances. Surgeons' expertise appears to be associated with outcomes. Further studies are needed to give clear recommendations.

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“…Different from the cecal ligation and puncture (CLP) sepsis model which gut perforation and fecal peritonitis are initiated by a puncture of the ligated cecum, mice with cecal ligation without puncture, here, show only a subtle systemic inflammation with relatively low mortality compared with the high mortality rate in CLP sepsis model [ 58 , 59 , 60 ]. The limited mortality in cecal-ligated mice supported the role of greater omentum in the control of intra-abdominal sources of infection (abscess or necrotic tissue) as reported in phlegmon appendicitis [ 5 ]. Although the systemic inflammation after cecal ligation was not severe enough to induce kidney or liver injury, different from the inflammation of the gut–kidney–liver axis in sepsis [ 7 ], the significant inflammatory responses in cecal-ligated mice were demonstrated by an increase in apoptosis of spleen.…”

Section: Discussionmentioning

confidence: 83%

“…Meanwhile, in the cases with successful antibiotic responses, the need for delayed surgical procedures is questioned because of the low risk of recurrent inflammation [ 4 ]. Although several interventions (ultrasonogram and computed tomography) were proposed to indicate the necessity of surgical procedures after successful supportive treatment [ 5 ], an alteration in gut microbiota or gut barrier damage might be another indicator.…”

Section: Introductionmentioning

confidence: 99%

Lacticaseibacillus rhamnosus dfa1 Attenuate Cecal Ligation-Induced Systemic Inflammation through the Interference in Gut Dysbiosis, Leaky Gut, and Enterocytic Cell Energy

Tongthong

Kaewduangduen

Phuengmaung

et al. 2023

IJMS

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Despite an uncommon condition, the clinical management of phlegmon appendicitis (retention of the intra-abdominal appendiceal abscess) is still controversial, and probiotics might be partly helpful. Then, the retained ligated cecal appendage (without gut obstruction) with or without oral Lacticaseibacillus rhamnosus dfa1 (started at 4 days prior to the surgery) was used as a representative model. At 5 days post-surgery, the cecal-ligated mice demonstrated weight loss, soft stool, gut barrier defect (leaky gut using FITC-dextran assay), fecal dysbiosis (increased Proteobacteria with reduced bacterial diversity), bacteremia, elevated serum cytokines, and spleen apoptosis without kidney and liver damage. Interestingly, the probiotics attenuated disease severity as indicated by stool consistency index, FITC-dextran assay, serum cytokines, spleen apoptosis, fecal microbiota analysis (reduced Proteobacteria), and mortality. Additionally, impacts of anti-inflammatory substances from culture media of the probiotics were demonstrated by attenuation of starvation injury in the Caco-2 enterocyte cell line as indicated by transepithelial electrical resistance (TEER), inflammatory markers (supernatant IL-8 with gene expression of TLR4 and NF-κB), cell energy status (extracellular flux analysis), and the reactive oxygen species (malondialdehyde). In conclusion, gut dysbiosis and leaky-gut-induced systemic inflammation might be helpful clinical parameters for patients with phlegmon appendicitis. Additionally, the leaky gut might be attenuated by some beneficial molecules from probiotics.

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Is Emergency Appendicectomy Better Than Elective Appendicectomy for the Treatment of Appendiceal Phlegmon?: A Review

Cited by 10 publications

References 26 publications

The Histopathology of the Appendix in Children at Interval Appendectomy

The Histopathology of the Appendix in Children at Interval Appendectomy

Appendiceal Phlegmon as an intraoperative finding: A retrospective analysis

Lacticaseibacillus rhamnosus dfa1 Attenuate Cecal Ligation-Induced Systemic Inflammation through the Interference in Gut Dysbiosis, Leaky Gut, and Enterocytic Cell Energy

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