Early versus delayed (interval) appendicectomy for the management of appendicular abscess and phlegmon: a systematic review and meta-analysis

Akingboye, Akinfemi; Mahmood, Fahad; Zaman, Shafquat; Wright, Jenny; Mannan, Fatima; Mohamedahmed, Ali Yasen Y.

doi:10.1007/s00423-020-02042-3

Cited by 14 publications

(8 citation statements)

References 21 publications

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“…Most of these complications (>90%) were classified as wound complications including wound infection. The 30-day overall (both major and minor) complication rate in all trials varied from 0% to 16.2% after appendectomy compared with complication rates of 0% to 26.3% in patients treated with antibiotics alone . In a meta-analysis of 2551 patients with acute appendicitis, the cumulative complication rate in the appendectomy group was 8.8%, vs 6.9% in the antibiotics group .…”

Section: Discussion and Observationsmentioning

confidence: 99%

Diagnosis and Management of Acute Appendicitis in Adults

Moris

Paulson

Pappas

2021

JAMA

182

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: Discussion and Observationsmentioning

confidence: 99%

Diagnosis and Management of Acute Appendicitis in Adults

Moris

Paulson

Pappas

2021

JAMA

182

113

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“…1 An appendicular abscess occurs between 2% and 10% of patients with appendicitis. 2 The presentation includes constant abdominal pain, fever, and histologic findings of chronic inflammation. 1 Only 1 case of chronic appendicular abscess presenting as bowel obstruction and 3 cases mimicking neoplasm have been reported in the literature.…”

Section: Discussionmentioning

confidence: 99%

Subacute Appendicular Abscess Masquerading as Neoplasia Causing Large Bowel Obstruction

2023

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Acute appendicitis is the most common reason for emergency abdominal surgery worldwide. Nonacute appendicitis variants include recurrent, subacute, and chronic appendicitis. Although these are not considered surgical emergencies, they are frequently overlooked, resulting in complications such as perforation or abscess formation. The presentation of nonacute forms is rare in the modern era because of sophisticated diagnostic modalities and treatment measures. We discuss a rare case of subacute appendicular abscess simulating a neoplasm with large bowel obstruction.

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“…The optimal timing of IA remains debatable, especially for CA. In many institutions, IA is performed after at least 1 month after conservative treatment [17]. The appropriate waiting period differs depending on the degree of inflammation and the patient’s general condition.…”

Section: Discussionmentioning

confidence: 99%

Usefulness of Preoperative Predictors of Pathological Complicated Appendicitis

Shiihara¹,

Sudo²,

Matsushita³

et al. 2023

Dig Surg

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Introduction: Complicated appendicitis (CA) is often indicated for emergency surgery; however, preoperative predictors of pathological CA (pCA) remain unclear. Furthermore, characteristics of CA that can be treated conservatively have not yet been established. Methods: 305 consecutive patients diagnosed with acute appendicitis were reviewed. The patients were divided into two groups: an emergency surgery and a conservative treatment group. The emergency surgery group was pathologically classified as having uncomplicated appendicitis (pUA) and pCA, and the preoperative predictors of pCA were retrospectively assessed. Based on the preoperative pCA predictors, a predictive nomogram whether conservative treatment would be successful or not was created. The predictors were applied to the conservative treatment group, and the outcomes were investigated. Results: In the multiple logistic regression analysis of the factors contributing to pCA, C-reactive protein ≥3.5 mg/dL, ascites, appendiceal wall defect, and periappendiceal fluid collection were independent risk factors. Over 90% of cases without any of the above four preoperative pCA predictors were pUA. The accuracy of the nomogram was 0.938. Conclusion: Our preoperative predictors and nomogram are useful to aid in distinguishing pCA and pUA and to predict whether or not conservative treatment will be successful. Some CA can be treated with conservative treatment.

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Early versus delayed (interval) appendicectomy for the management of appendicular abscess and phlegmon: a systematic review and meta-analysis

Cited by 14 publications

References 21 publications

Diagnosis and Management of Acute Appendicitis in Adults

Diagnosis and Management of Acute Appendicitis in Adults

Subacute Appendicular Abscess Masquerading as Neoplasia Causing Large Bowel Obstruction

Usefulness of Preoperative Predictors of Pathological Complicated Appendicitis

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