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Objectives: To develop a routinely applicable severity index for the management of acute appendicitis in adults using combined clinical and radiological parameters and retroperitoneal space planes (RSP).
Methods: Two hundred consecutive patients with histologically proven acute appendicitis and available presurgical CT scans were analysed retrospectively. Two radiologists assessed all CT scans for morphologic sings of appendicitis and six RSP. Clinical parameters were age, body temperature, C-reactive protein (CRP), white blood cell count, and duration of symptoms. Radiological parameters were appendix diameter and wall thickness, periappendiceal fat stranding and fluid, intraluminal and extraluminal air, thinning of appendiceal wall, caecal wall thickening, appendicolith and abscess formation.
Results: One hundred and three patients (51%) had histologically proven complicated appendicitis. Based on three clinical (age ≥52 years, body temperature ≥37.5°C, duration of symptoms ≥48 h) and four computed tomography (CT) findings (appendix diameter ≥14 mm, presence of periappendiceal fluid, extraluminal air, perityphlitic abscess), the APSI was developed using regression coefficients of multivariate logistic regression analyses with a maximum of 10 points. A score of ≥4 points predicted complicated appendicitis with a positive predictive value of 92% and a negative predictive value of 83%. Substantial to excellent interobserver agreement was found for the four radiological parameters of the APSI [intraclass correlation coefficient (ICC), 0.78-0.83]. The RSP evaluation presented no added value for the diagnosis of complicated appendicitis.
Conclusions: Using APSI, an accurate and simple prediction of complicated appendicitis in adults was possible. The RSP count was not useful for the diagnosis of complicated appendicitis.
Key Points: • Appendicitis severity score provides an accurate and simple prediction of complicated appendicitis • Appendicitis severity score ≥4 accurately predicted complicated appendicitis (PPV 92%;NPV 83%) • Evaluation of retroperitoneal space planes was not useful in diagnosing complicated appendicitis.
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http://dx.doi.org/10.1007/s00330-018-5339-9 | DOI Listing |
World J Emerg Surg
December 2024
Diagnostic Image Analysis Group, Department of Medical Imaging, Radboud University Medical Center, Nijmegen, the Netherlands.
Background: Acute abdominal pain (AAP) constitutes 5-10% of all emergency department (ED) visits, with appendicitis being a prevalent AAP etiology often necessitating surgical intervention. The variability in AAP symptoms and causes, combined with the challenge of identifying appendicitis, complicate timely intervention. To estimate the risk of appendicitis, scoring systems such as the Alvarado score have been developed.
View Article and Find Full Text PDFJ Surg Case Rep
December 2024
College of Medicine, QU Health, Qatar University, 2713 Doha, Qatar.
Duplication of the vermiform appendix is a rare anomaly observed in patients undergoing appendectomy. A 27-month-old male toddler presented with a 9-day history of abdominal pain, vomiting, and diarrhea, progressing to an acute abdomen with signs of severe peritonitis. Intraoperative findings revealed a periappendicular infiltrate from a perforated vermiform appendix of the tenia coli type.
View Article and Find Full Text PDFCureus
November 2024
General Surgery, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, IND.
Background: Appendicular perforation is a severe complication of acute appendicitis, leading to increased morbidity and complex post-surgical outcomes. Early identification of patients at risk of perforation is crucial to improve clinical management and reduce complications. This study aims to review and summarize the predictive value of clinical, biochemical, and radiological factors in determining the likelihood of appendicular perforation.
View Article and Find Full Text PDFCureus
November 2024
General Surgery, Ankara Etlik City Hospital, Ankara, TUR.
Acute appendicitis typically causes right lower quadrant pain, but in elderly patients with comorbidities, it can present atypically, complicating diagnosis. This case highlights a rare presentation, mimicking sigmoid diverticulitis. A 70-year-old man with chronic heart failure, arrhythmia, and renal failure presented with two days of left lower quadrant pain.
View Article and Find Full Text PDFArch Gynecol Obstet
December 2024
Laboratory of Healthcare Research and Pharmacoepidemiology, Division of Biostatistics, Epidemiology and Public Health, Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Via Bicocca degli Arcimboldi, 8 (Building U7), 20126, Milan, Italy.
Purpose: Acute appendicitis during pregnancy poses unique challenges due to altered anatomical and physiological dynamics and concern about foetal well-being. This study aimed to assess management strategies and outcomes of acute appendicitis during pregnancy, focusing on non-operative management versus surgical intervention.
Methods: The study is based on the computerized healthcare utilization database of Lombardy.
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