Prevalence of Appendicoliths Detected at CT in Adults With Suspected Appendicitis

Ranieri, Daniel M; Enzerra, Michael; Pickhardt, Perry J.

doi:10.2214/ajr.20.23149

Cited by 23 publications

(20 citation statements)

References 19 publications

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Section: Discussion and Observationsmentioning

confidence: 99%

“…Appendicoliths are incidentally discovered by CT in approximately 4% of asymptomatic patients . However, approximately 40% of patients with acute appendicitis have appendicoliths identified by CT . Ranieri et al showed that in 248 patients with acute appendicitis, the presence of appendicoliths was associated with more extensive or severe inflammation and an increased (38.7% vs 4.4%) risk of perforation ( P < .05 for both).…”

Section: Discussion and Observationsmentioning

confidence: 99%

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Diagnosis and Management of Acute Appendicitis in Adults

Moris

Paulson

Pappas

2021

JAMA

180

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%

Section: Discussion and Observationsmentioning

confidence: 99%

Diagnosis and Management of Acute Appendicitis in Adults

Moris

Paulson

Pappas

2021

JAMA

180

113

View full text Add to dashboard Cite

show abstract

“…The presence of appendicolith is associated with complicated appendicitis in our univariate analysis but—in contrary to previous reports—it is not statistically significant in the multivariate regression analysis. Appendicoliths have been found significantly more frequent among those with acute appendicitis, associated with increased inflammation, risk of perforation, and considered one of the risk factors for complicated appendicitis [ 13 , 38 ]. Their presence is among an exclusion from clinical trials of NOM in acute appendicitis such as the Appendicitis Acuta (APPAC) trials [ 9 , 10 , 39 ].…”

Section: Discussionmentioning

confidence: 99%

Predictive ability of CT findings in the differentiation of complicated and uncomplicated appendicitis: a retrospective investigation of 201 patients undergone appendectomy at initial admission

et al. 2021

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Background Paradigm shift toward nonoperative management (NOM) of adult appendicitis has made computed tomography (CT) more important than ever, particularly in differentiating complicated from uncomplicated disease. Complete surgical and pathological data of appendicitis in a place where appendectomy at initial admission is a standard of care would allow retrospective review of preoperative CT for performance and predictive ability in identifying those that may benefit from NOM in the future. Results The study included 201 CT scans of consecutive adult patients who presented for appendectomy at initial admission with pathologically confirmed acute appendicitis. Complicated appendicitis referred to gangrene or perforation on pathological or operative findings. The overall CT sensitivity, specificity and accuracy for differentiation of complicated from uncomplicated appendicitis were 87.2%, 75.7% and 81.1%, respectively. The most sensitive CT findings of complicated appendicitis were mucosal enhancement defect (83.2%; 95% CI 74.1–90.0) and moderate-to-severe periappendiceal fat stranding (96.8%; 95% CI 91.1–99.3), both independently predictive of complicated appendicitis with adjusted odds ratios (ORs) of 4.62 (95% CI 1.86–11.51) and 4.41 (95% CI 1.06–18.29), respectively. Phlegmon, fluid collection, extraluminal appendicolith, periappendiceal air and small bowel dilatation had specificity of 98.1–100%. Intraluminal appendicoliths were found more frequently in complicated appendicitis (52.6% vs. 22.6%) but not predictive for this diagnosis. Independent clinical predictors of complicated appendicitis were lack of pain migration (OR 2.06), neutrophilia ≥ 82% (OR (2.87) and symptoms ≥ 24 h (OR 5.84). Conclusions CT findings were highly accurate in differentiating complicated from uncomplicated appendicitis among patients undergone appendectomy at initial admission.

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“…The lifetime risk of development of AA is estimated to be approximately 8% [1][2][3][4]. AA can be divided into uncomplicated and complicated with either perforation, abscess, peritonitis, or mass [4][5][6][7][8].…”

Section: Introductionmentioning

confidence: 99%

Presentation and outcomes of acute appendicitis during COVID-19 pandemic: lessons learned from the Middle East—a multicentre prospective cohort study

Nakeeb

Emile

AbdelMawla

et al. 2022

Int J Colorectal Dis

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Background The coronavirus disease 2019 (COVID-19) pandemic had a striking impact on healthcare services in the world. The present study aimed to investigate the impact of the COVID-19 pandemic on the presentation management and outcomes of acute appendicitis (AA) in different centers in the Middle East. Methods This multicenter cohort study compared the presentation and outcomes of patients with AA who presented during the COVID-19 pandemic in comparison to patients who presented before the onset of the pandemic. Demographic data, clinical presentation, management strategy, and outcomes were prospectively collected and compared. Results Seven hundred seventy-one patients presented with AA during the COVID pandemic versus 1174 in the pre-COVID period. Delayed and complex presentation of AA was significantly more observed during the pandemic period. Seventy-six percent of patients underwent CT scanning to confirm the diagnosis of AA during the pandemic period, compared to 62.7% in the pre-COVID period. Non-operative management (NOM) was more frequently employed in the pandemic period. Postoperative complications were higher amid the pandemic as compared to before its onset. Reoperation and readmission rates were significantly higher in the COVID period, whereas the negative appendicectomy rate was significantly lower in the pandemic period (p = 0.0001). Conclusion During the COVID-19 pandemic, a remarkable decrease in the number of patients with AA was seen along with a higher incidence of complex AA, greater use of CT scanning, and more application of NOM. The rates of postoperative complications, reoperation, and readmission were significantly higher during the COVID period.

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Prevalence of Appendicoliths Detected at CT in Adults With Suspected Appendicitis

Cited by 23 publications

References 19 publications

Diagnosis and Management of Acute Appendicitis in Adults

Diagnosis and Management of Acute Appendicitis in Adults

Predictive ability of CT findings in the differentiation of complicated and uncomplicated appendicitis: a retrospective investigation of 201 patients undergone appendectomy at initial admission

Presentation and outcomes of acute appendicitis during COVID-19 pandemic: lessons learned from the Middle East—a multicentre prospective cohort study

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