Negative appendectomy rate in patients diagnosed with acute appendicitis

Chaochankit, Wongsakorn; Boocha, Aeraungkoon; Samphao, Srila

doi:10.21203/rs.3.rs-1905669/v1

Cited by 1 publication

(1 citation statement)

References 20 publications

(17 reference statements)

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“…48 In addition to the high diagnostic accuracy, CT is a costeffective tool in guiding management because its application in patients with suspected appendicitis leads to fewer negative appendectomies (defined as operations performed for suspected appendicitis in which the appendix is found to be normal on histologic evaluation), avoidance of unnecessary hospital admissions, and prompt identification of alterative disease processes. 49,50 A limitation of CT is exposure to ionizing radiation. Thus, discussion between physician and patient should take place about the risks and benefits of CT after taking into consideration the individual patient characteristics including age, potential for alternative diagnoses, and pregnancy.…”

Section: Assessment and Diagnosismentioning

confidence: 99%

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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Section: Assessment and Diagnosismentioning

confidence: 99%