Correlating surgical and pathological diagnoses in pediatric appendicitis

Fallon, Sara C.; Kim, Michael E.; Hallmark, Charlene A.; Carpenter, Jennifer L.; Eldin, Karen W.; López, Mónica E.; Wesson, David E.; Brandt, Mary L.; Rodriguez, J. Rubén

doi:10.1016/j.jpedsurg.2014.11.001

Cited by 51 publications

(47 citation statements)

References 9 publications

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“…Our results showed discrepancies between the operative and pathological diagnoses of appendicitis in 10 of 49 cases. However because the operative diagnosis dictates clinical management at the time of surgery and has been shown to better predict postoperative complications, we used the operative diagnosis as the reference standard for appendicitis in our statistical analysis [13].…”

Section: Discussionmentioning

confidence: 99%

“…Clinical follow-up consisted of observation in the emergency department until an alternative diagnosis explaining the child's pain was established or the child was pain-free and tolerating food. Although the operative diagnosis and pathological diagnosis of appendicitis frequently differ, we used the operative diagnosis for statistical analyses because it has been shown to better predict the postoperative course [13,14]. Recorded US features were correlated with reference standards of operative diagnosis or clinical followup by multivariate analysis via logistic regression using Statistical Analysis System 9.3 (SAS Institute Inc., Cary, NC).…”

Section: Methodsmentioning

confidence: 99%

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Searching for certainty: findings predictive of appendicitis in equivocal ultrasound exams

et al. 2016

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Loss of mural stratification, peri-appendiceal fat inflammation and an appendicolith are significant predictors of appendicitis in children with otherwise equivocal US exams. While maximum appendiceal diameter is not statistically associated with appendicitis in our study, mean appendiceal diameter of 6.7 mm in those without appendicitis suggests that the customary upper normal limit of 6 mm is too sensitive.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Searching for certainty: findings predictive of appendicitis in equivocal ultrasound exams

et al. 2016

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“…Suppurative and gangrenous types without localized abscess or peritonitis were included in the suppurative appendicitis category. If there were discrepancies between the surgical findings and the pathological diagnoses, the type of appendicitis was decided based on the surgical findings, as the operative diagnosis is more predictive of clinical outcome than the pathological diagnosis [15] .…”

Section: Methodsmentioning

confidence: 99%

Risk Factors for Postoperative Intra-Abdominal Abscess after Laparoscopic Appendectomy: Analysis for Consecutive 1,817 Experiences

et al. 2015

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Background: Possible risk factors for postoperative intra-abdominal abscess (IAA) formation after laparoscopic appendectomy (LA) remain controversial. A perforated appendicitis, diabetes mellitus, peritoneal irrigation, obesity and age are considered to be possible risk factors for postoperative IAA, but the existing evidence is insufficient. This study aimed to identify the risk factors for IAA formation in patients receiving LA. Methods: Between January 2010 and December 2013, 1,817 patients who underwent 3-port LA were enrolled in this study. Patients were classified into 2 groups according to the development of postoperative IAA, and the differences between the groups were analyzed. Results: The incidence of IAA after LA was 1.5%, and the only identified risk factor for IAA was peritoneal irrigation. On logistic regression analysis of those patients who received peritoneal irrigation, suppurative appendicitis and non-placement of the peritoneal drain were found to be significant risk factors for the development of IAA. Conclusions: Peritoneal irrigation in a case of abdomen contamination was shown to be a risk factor for the development of postoperative IAA after LA. When peritoneal irrigation is performed, surgeons should consider using peritoneal drainage and postoperative antibiotics (including anti-anaerobic antibiotics) to prevent postoperative IAA formation.

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“…What adds to the woes are the reports of significant discordance between operative and histopathological diagnosis. 15,16 There has been a paradigm shift in the clinician's outlook as far as the optimal management of AA is concerned. Firstly, the clinicians are now striving to achieve the lowest possible NAR using whatever diagnostic means available today.…”

Section: Clinical Perspectivesmentioning

confidence: 99%

Imaging in acute appendicitis: What, when, and why?

Debnath

George

Ravikumar

2017

Medical Journal Armed Forces India

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m e d i c a l j o u r n a l a r m e d f o r c e s i n d i a 7 3 ( 2 0 1 7 ) 7 4 -7 9 a r tLaboratory results are often non-specific. Imaging has an important role not only in diagnosing appendicitis and its complication but also suggesting alternate diagnosis in appropriate cases. However, there is no universally accepted diagnostic imaging algorithm for appendicitis. Imaging of acute appendicitis needs to be streamlined keeping pros and cons of the available investigative modalities. Radiography has practically no role today in the diagnosis and management of acute appendicitis. Ultrasonography (USG) should be the first line imaging modality for all ages, particularly for children and non-obese young adults including women of reproductive age group. If USG findings are unequivocal and correlate with clinical assessment, no further imaging is needed. In case of equivocal USG findings or clinico-radiological dissociation, follow-up/further imaging (computed tomography (CT) scan/magnetic resonance imaging (MRI)) is recommended. In pediatric and pregnant patients with inconclusive initial USG, MRI is the next option. Routine use of CT scan for diagnosis of AA needs to be discouraged. Our proposed version of a practical imaging algorithm, with USG first and always has been incorporated in the article. #

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Correlating surgical and pathological diagnoses in pediatric appendicitis

Cited by 51 publications

References 9 publications

Searching for certainty: findings predictive of appendicitis in equivocal ultrasound exams

Searching for certainty: findings predictive of appendicitis in equivocal ultrasound exams

Risk Factors for Postoperative Intra-Abdominal Abscess after Laparoscopic Appendectomy: Analysis for Consecutive 1,817 Experiences

Imaging in acute appendicitis: What, when, and why?

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