Management of Acute Abdomen: Acute Appendicitis

Neupane, BR; Paudel, SR; Shrestha, Asmita; Bijukchhe, Sunil Man; Bhattarai, Abhishek; Subedi, P. K.

doi:10.3126/jgmcn.v12i2.27149

Cited by 3 publications

(5 citation statements)

References 15 publications

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“…In a similar study of Gandaki Medical College Pokhara, out of 1021, 203 (19.88%) were managed conservatively whereas 818 (80.11%) were surgically managed. 11 In our study, 160 (49.84) were managed surgically while 160 (49.84) were managed conservatively. However, Appendectomy, via open laparotomy through a limited right lower quadrant incision or via laparoscopy, is the standard treatment for acute appendicitis.…”

Section: Discussionmentioning

confidence: 69%

Appendicitis among Patients Admitted to the Department of Surgery of a Tertiary Care Centre: A Descriptive Cross-sectional Study

Deo¹,

Yogi²,

Niroula³

et al. 2023

J Nepal Med Assoc

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Introduction: The prevalence of appendicitis is widespread among both adult and pediatric populations. Despite being so common, its diagnosis remains difficult. Initially, acute appendicitis is managed conservatively. To reduce morbidity and mortality, surgery must be performed promptly. The main objective of the study is to find out the prevalence of appendicitis among patients admitted to the department of surgery of a tertiary care centre. Methods: A descriptive cross-sectional study was conducted among patients admitted to the Department of Surgery of a tertiary care centre from 1 July 2021 to 1 July 2022. Ethical approval was obtained from the Institutional Review Committee (Reference number: 202/2079/80). Convenience sampling was done. The patient admitted to the Department of Surgery during the study period was included. Point estimate and 95% Confidence Interval were calculated. Results: Out of 2452 patients, the prevalence of appendicitis was 321 (13.09%) (11.75-14.43, 95% Confidence Interval). The mean age of the patients with appendicitis was 31.57±14.14 years and among them, males were 176 (54.83%). Conclusions: The prevalence of appendicitis among patients admitted to the department of surgery of a tertiary care centre was lower compared to other studies conducted in similar settings.

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Section: Discussionmentioning

confidence: 69%

Appendicitis among Patients Admitted to the Department of Surgery of a Tertiary Care Centre: A Descriptive Cross-sectional Study

Deo¹,

Yogi²,

Niroula³

et al. 2023

J Nepal Med Assoc

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“…e diagnosis of acute uncomplicated appendicitis depends on history and clinical exam, laboratory investigations, mainly the inflammatory markers triad (leukocytosis, neutrophilia, and C-reactive protein), and imaging, mainly ultrasound, which was done for all patients and CT scan which was done only for query cases (46 patients). 10 * Alvarado score: 0-4: unlikely appendicitis; 5-6: equivocal for appendicitis; 7-8: probably appendicitis; 9-10: most likely appendicitis (Table 1 is from Neupane et al [5] under the Creative Commons Attribution License/Public Domain).…”

Section: Resultsmentioning

confidence: 99%

“… ∗ Alvarado score: 0–4: unlikely appendicitis; 5-6: equivocal for appendicitis; 7-8: probably appendicitis; 9-10: most likely appendicitis ( Table 1 is from Neupane et al [ 5 ] under the Creative Commons Attribution License/Public Domain). …”

Section: Tablementioning

confidence: 99%

Appendicectomy for Uncomplicated Simple Appendicitis: Is It Always Required?

Alsubsiee

2021

Surgery Research and Practice

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Background. Although appendicectomy is still the classical and standard treatment for acute appendicitis, initial conservative antibiotic only treatment for simple uncomplicated cases has been proposed and tried as a feasible and effective approach. The objective of this study was to evaluate the efficacy and outcomes of antibiotics treatment for acute simple uncomplicated appendicitis. Methods. This is a prospective controlled nonrandomized study in which a total of 156 patients whose ages range from 16 to 54 years presenting with clinical diagnosis of acute uncomplicated appendicitis were assigned for conservative antibiotics treatment, which consists of ceftriaxone I gram twice daily and metronidazole infusions, 500 mg in 100 ml, 3 times daily for 48 to 72 hours to be converted on oral antibiotics after clinical improvement for 5 to 7 days. Patients who failed to initial conservative treatment and those who had recurring symptoms of appendicitis were presented for appendectomy. Results. Antibiotic treatment was successful and feasible in 138 (88.5%) patients. Progression of the signs and symptoms despite full medical treatment was observed in 11 (7%) patients during the same admission. Further 7 (4.5%) patients showed recurrence of the symptoms during follow-up period of 6–12 months after successful initial conservative treatment and also proceeded for appendicectomy. Conclusion. Nonoperative antibiotic treatment of acute simple appendicitis is safe, feasible, and effective for properly selected cases, thus avoiding unnecessary surgery with its possible complications.

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“…A large cross-sectional observational study by Neupane et al . in 2019 53 with 1021 patients suggested that AS is significantly higher in patients with AA as compared to patients with other diseases. They identified the large variation in presentation, severity of disease, radiological work-up, and surgical management of AA.…”

Section: Discussionmentioning

confidence: 96%

“…The classification of AS was different in every study, which made statistical modeling more difficult. Some of the studies 51 – 46 , 53 have calculated AS retrospectively, which underestimates the true performance of AS (raises the possibility of performance bias). Variables collected in each study were different from one another, and there was a lot of missing data when we combined the data, leading to statistical heterogeneity.…”

Section: Discussionmentioning

confidence: 99%

A systematic review and meta-regression for validation of the Alvarado score as a tool for predicting acute appendicitis

Gupta

Kolli

Costa

et al. 2023

Annals of Medicine &Amp; Surgery

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Background: The Alvarado score (AS) has not been widely used for diagnosing acute appendicitis although it has shown to be a good predictor for diagnosing appendicitis. The aim was to perform a systematic review of the available literature and synthesize the evidence. Methods: A systematic review was performed as per the PRISMA guidelines using search engines like Ovid, PubMed, and Google Scholar with predefined, strict inclusion and exclusion criteria. The quality assessment of included studies was performed using the QUADAS 2 tool. Summary statistics were performed for all variables. A linear regression model was performed between dependent and independent variables using STATA software. Heterogeneity testing showed significant heterogeneity within the included studies; hence, a forest plot with pooled estimates could not be constructed, and therefore a meta-regression was performed. Results: Seventeen full-text articles met inclusion and exclusion criteria. Ten of which were identified as low-risk studies. Five studies were included in final data pooling with total patients being 2239 and mean age of 31.9 years. (1) Linear regression demonstrated an association between ‘histological appendicitis’ and ‘AS 7–0’ with patients receiving intervention, with a significant P value of less than 0.005. (2) Meta-regression demonstrated a positive coefficient (0.298), a positive Z score of 2.20 with a significant P value of 0.028 for patients with ‘high AS’ who received interventions that were significantly proven to be ‘histologically appendicitis’, indicating a cause-and-effect relationship. Conclusion: High AS (7 and above) is a significant predictor of acute appendicitis. The authors recommend further prospective randomized clinical trials to establish a cause-and-effect relationship.

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Management of Acute Abdomen: Acute Appendicitis

Cited by 3 publications

References 15 publications

Appendicitis among Patients Admitted to the Department of Surgery of a Tertiary Care Centre: A Descriptive Cross-sectional Study

Appendicitis among Patients Admitted to the Department of Surgery of a Tertiary Care Centre: A Descriptive Cross-sectional Study

Appendicectomy for Uncomplicated Simple Appendicitis: Is It Always Required?

A systematic review and meta-regression for validation of the Alvarado score as a tool for predicting acute appendicitis

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