The Characteristics of Appendicoliths Associated with Acute Appendicitis

Chaudhry, Mustafa Belal Hafeez; Shahzad, Noman; Khan, Muhammad Sohaib; Wajid, Maryiam; Memon, Wasim; Alvi, Rehman

doi:10.7759/cureus.5322

Cited by 6 publications

(5 citation statements)

References 14 publications

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“…Evidence from a cross-sectional study of 321 patients with appendicoliths identified on CT determined the characteristics of appendicoliths that are associated with acute appendicitis. Multiple appendicoliths (62% with appendicitis vs 38% with no appendicitis, P = .02) or appendicoliths larger than 5 mm (69% with appendicitis vs 13% with no appendicitis, P < .001) as well as appendicoliths at the base of the appendix (33% with appendicitis vs 15% with no appendicitis, P < .001) were independently associated with the presence of acute appendicitis …”

Section: Discussion and Observationsmentioning

confidence: 99%

Diagnosis and Management of Acute Appendicitis in Adults

Moris

Paulson

Pappas

2021

JAMA

110

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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: Discussion and Observationsmentioning

confidence: 99%

Diagnosis and Management of Acute Appendicitis in Adults

Moris

Paulson

Pappas

2021

JAMA

110

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“…Most of these adverse events are minor and may attenuate after prolonged use and metformin would have to be discontinued because of severe gastrointestinal symptoms in only approximately 5% of the users 27 . Because appendicoliths may potentially lead to acute appendicitis 1 , 28 , the promotion of intestinal motility resulting from these adverse effects of metformin may reduce the risk of acute appendicitis because of the reduced occurrence of appendix obstruction by appendicoliths. Because prolonged/slow-release metformin may only have minimal improvement of gastrointestinal intolerance than conventional/immediate-release formulations 29 , it is not surprising that the use of either formulation was associated with a similarly lower risk of acute appendicitis (Table 3 , Models XIII and XIV) taking the increased gut motility as a potential mechanism.…”

Section: Discussionmentioning

confidence: 99%

Metformin use is associated with a reduced risk of acute appendicitis in Taiwanese patients with type 2 diabetes mellitus

Tseng

2021

Sci Rep

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This retrospective cohort study used the nationwide database of Taiwan’s National Health Insurance to investigate whether metformin would reduce the risk of acute appendicitis in patients with type 2 diabetes mellitus. We first identified 423,949 patients newly diagnosed of diabetes from 1999 to 2005. After excluding patients having type 1 diabetes mellitus, missing data, previous history of acute appendicitis, aged < 15 years, aged > 80 years and followed up for < 6 months, 338,172 ever users and 21,861 never users of metformin were followed up from January 1, 2006 until December 31, 2011. Incidence of acute appendicitis was estimated for never users, ever users and subgroups (divided by median, tertiles and quartiles, respectively) of dose–response indicators including cumulative duration (months), cumulative dose (mg) and average daily dose (mg/day) of metformin therapy. We used Cox regression incorporated with the inverse probability of treatment weighting using propensity score to estimate the overall hazard ratio for ever versus never users, and the hazard ratios for subgroups of dose–response indicators versus never users. Results showed that new-onset acute appendicitis was diagnosed in 1558 ever users and 179 never users during follow-up. The incidence was 98.15 per 100,000 person-years in ever users and was 189.48 per 100,000 person-years in never users. The overall hazard ratio (95% confidence interval) of 0.514 (0.441–0.600) suggested a lower risk of acute appendicitis associated with metformin use. A dose–response pattern was consistently observed in the analyses of different subgroups of dose–response indicators and the reduced risk associated with metformin use was consistently observed in various sensitivity analyses. An average daily dose of 1000–1500 mg/day can significantly reduce the risk by > 50%. The benefit did not differ between different formulations of metformin, and the estimated hazard ratio for conventional/immediate-release metformin versus never users was 0.516 (0.441–0.603) and was 0.509 (0.421–0.615) for prolonged/slow-release metformin versus never users. It is concluded that metformin use is associated with a reduced risk of acute appendicitis in patients with type 2 diabetes mellitus.

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“…Khan et al. [ 8 ] in a cross-sectional study on 321 patients, demonstrated that CT findings of more than one appendicolith and an appendicolith diameter larger than 5 mm on CT were associated with a higher likelihood of concomitant acute appendicitis. Ishiyama et al.…”

Section: Discussionmentioning

confidence: 99%

Acute appendicitis with four appendicoliths: a first case report in the English literature

Lafleche

Pillay

2020

Journal of Surgical Case Reports

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This is an extremely rare presentation of multiple appendicoliths in one appendix. Multiple appendicoliths as well as appendicoliths larger than 5 mm have been implicated in severe appendicitis as well as perforation and gangrene of the appendix. There is no known correlation with appendicular malignancy. The controversy arises in the surgical management of asymptomatic patients. There is emerging evidence that justifies an elective appendicectomy in asymptomatic patients.

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The Characteristics of Appendicoliths Associated with Acute Appendicitis

Cited by 6 publications

References 14 publications

Diagnosis and Management of Acute Appendicitis in Adults

Diagnosis and Management of Acute Appendicitis in Adults

Metformin use is associated with a reduced risk of acute appendicitis in Taiwanese patients with type 2 diabetes mellitus

Acute appendicitis with four appendicoliths: a first case report in the English literature

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