The Natural History of Appendicitis in Adults A Prospective Study

Temple, Claire; Huchcroft, Shirley A.; Temple, Walley J.

doi:10.1097/00000658-199503000-00010

Cited by 290 publications

(194 citation statements)

References 2 publications

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“…With increasing age there is an increasing number of potential differential diagnoses that could delay a correct diagnosis. Late presentation may also be a contributing factor 29 . It has been suggested that the high proportion of perforations in the elderly is a mere consequence of the relatively low incidence of NPA among these patients 30 .…”

Section: Discussionmentioning

confidence: 99%

Impact of body mass index and tobacco smoking on outcome after open appendicectomy

Sadr–Azodi

Lindström

Adami

et al. 2008

British Journal of Surgery

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Background: The effect of body mass index (BMI) and smoking on the risk of perforated appendix and postoperative complications in patients undergoing open appendicectomy for acute appendicitis was studied. Results: After adjustment for age, calendar period and BMI, smoking was significantly associated with an increased risk of perforated appendicitis (PA) (P = 0·004). The relative risk was 1·29 (95 per cent confidence interval 1·11 to 1·50) among current smokers with more than 10 pack-years of tobacco use. In patients with non-perforated appendicitis (NPA), the relative risk of overall postoperative complications was significantly associated with BMI (P < 0·001), and was 2·60 (1·71 to 3·95) in obese patients and 1·51 (1·03 to 2·22) in current smokers with more than 10 pack-years of tobacco use. In patients with PA, overweight, obesity and smoking status were not associated with an increased risk of overall postoperative complications.Conclusion: Perforation due to acute appendicitis was associated with current tobacco smoking. A BMI of 27·5 kg/m 2 or more and current smoking were associated with overall postoperative complications in patients with NPA.

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Section: Discussionmentioning

confidence: 99%

Impact of body mass index and tobacco smoking on outcome after open appendicectomy

Sadr–Azodi

Lindström

Adami

et al. 2008

British Journal of Surgery

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show abstract

Section: Introductionmentioning

confidence: 99%

“…[1][2][3][4] The mortality risk is <1% in non-perforated appendicitis, 5 but increase to 4%-8% in the elderly. 1,2,5,6 Delay before appendectomy is associated with increase in perforation rate. 7,8 Acute perforated appendicitis is still associated with significant morbidity and mortality in the elderly patients and we still need to strive for early detection of perforation.…”

Section: Introductionmentioning

confidence: 99%

Delta neutrophil index: A reliable marker to differentiate perforated appendicitis from non‐perforated appendicitis in the elderly

Shin

Cho

Kim

et al. 2017

Clinical Laboratory Analysis

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Background Delta neutrophil index (DNI) is a new inflammatory marker and the present study aimed to evaluate the predictive value of the DNI for the presence of a perforation in elderly with acute appendicitis. Methods This retrospective observational study was conducted on 108 consecutive elderly patients (≥65 years old) with acute appendicitis treated over a 24‐month period. Results Sixty‐nine of the 108 patients (median, IQR: 72, 67‐77 years) were allocated to the perforated appendicitis group (63.9%) and 39 to the non‐perforated appendicitis group (36.1%). WBC, neutrophil‐to‐lymphocyte ratio, platelet‐to‐lymphocyte ratio and DNI were significantly higher in the perforated group. In multiple logistic regression analyses, initial DNI was the only independent marker that can significantly predict the presence of perforation in multiple regression [odds ratio 9.38, 95% confidence interval (2.51‐35.00), P=.001]. Receiver operator characteristic curve analysis showed that DNI is a good predictor for the presence of appendiceal perforation at an optimal cut‐off for DNI being 1.4% (sensitivity 67.7%, specificity 90.0%, AUC 0.807). Conclusion Clinicians can reliably differentiate acute perforated appendicitis from non‐perforated appendicitis by DNI level of 1.4 or more in elderly patients.

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“…Appendicular perforation ranges 50-90% in various series. 6,7 The importance of laboratory investigations like White Blood Cell (WBC) counts and C-reactive protein (CRP) etc. values has been stressed to supplement the clinical diagnosis and to reduce the frequency of unnecessary appendicectomy.…”

Section: Introductionmentioning

confidence: 99%

Hyperbilirubinemia as a predictor of the severity of acute appendicitis - an observational study

et al. 2017

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Background: Appendicitis is the most common acute abdominal condition requiring emergency surgery, with a lifetime risk of 6%. Appendectomy continues to be one of the commonest procedures in general surgery, accounts for approximately 1% of all surgical operation. Despite the increased use of ultrasonography, computed tomography scanning and laparoscopy, the rate of misdiagnosis of appendicitis has remained constant (15.3%). The aim of this study was to whether Serum Bilirubin can be considered as a new laboratory marker to aid in the diagnosis of acute appendicitis and if so, does it have the predictive capacity to warn us about complicated appendicitis.Methods: This was prospective observational study done in Mahatma Gandhi Medical College and Research Institute, Pondicherry between November 2014 and August 2016. About 110 patients of acute appendicitis who had undergone appendicectomy were studied. Data was collected and analyzed critically.Results: Males 66 (60%) outnumbered females 44 (40%) and overall mean age was 26.61±12.37 years. Of the 110 patients, 9% were normal appendix, 59.09% were confirmed as acute appendicitis while 31.81% were diagnosed with complicated appendicitis on biopsy. The Sensitivity and Specificity of serum bilirubin as a marker in predicting Acute appendicitis and complicated appendicitis was 47.6% and 90.9% respectively. Similarly, the Positive predicative value and Negative predicative value for the same was 88.5% and 61.5% respectively with odds ratio 12.4 with significant p value <0.0001.Conclusions: Serum bilirubin is easily available test and cheap and can be estimated from the sample of blood drawn for routine blood investigations. Patients with clinical signs and symptoms of appendicitis and with hyperbilirubinemia should be identified as having a higher probability of complicated appendicitis. Hence, serum bilirubin levels have a predictive potential for the diagnosis of severity of acute appendicitis and need for early appendicectomy. If total serum bilirubin is added to already existing laboratory tests, then the diagnosis of complicated appendicitis in clinically suspected cases can be made with fair degree of accuracy, the need for CECT and MRI can be reduced and unnecessary delay in appendicectomy can be avoided.

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The Natural History of Appendicitis in Adults A Prospective Study

Cited by 290 publications

References 2 publications

Impact of body mass index and tobacco smoking on outcome after open appendicectomy

Impact of body mass index and tobacco smoking on outcome after open appendicectomy

Delta neutrophil index: A reliable marker to differentiate perforated appendicitis from non‐perforated appendicitis in the elderly

Hyperbilirubinemia as a predictor of the severity of acute appendicitis - an observational study

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