The Diagnostic Differentiation Challenge in Acute Appendicitis: How to Distinguish between Uncomplicated and Complicated Appendicitis in Adults

Abstract

(1) Background: How to best define, diagnose and differentiate uncomplicated from complicated acute appendicitis remains debated. Hence, the aim of this review was to present an overview of the current knowledge and emerging field of acute appendicitis with a focus on the diagnostic differentiation of severity currently subject to ongoing investigations. (2) Methods: We conducted a PubMed search using the MeSH terms “appendicitis AND severity” and “appendicitis AND classification”, with a focus on studies calling appendicitis as ‘uncomplicated’ or ‘complicated’. An emphasis on the last 5 years was stressed, with further studies selected for their contribution to the theme. Further studies were retrieved from identified full-text articles and included per the authors’ discretion. (3) Results: The assumption that appendicitis invariably will proceed to perforation has been outdated. Both uncomplicated and complicated appendicitis exist with likely different pathophysiology. Hence, this makes it important to differentiate disease severity. Clinicians must diagnose appendicitis, but, in the next step, also differentiate between uncomplicated and complicated appendicitis in order to allow for management decisions. Diagnostic accuracy without supportive imaging is around 75–80% and, based on clinical judgement and blood tests alone, the negative appendectomy rate has been described as high as 36%. More research is needed on available biomarkers, and the routine use of imaging still remains debated. Scoring systems have the potential to improve diagnostic accuracy, but no scoring system has yet been validated for differentiating disease severity. Currently, no universally agreed definition exists on what constitutes a complicated appendicitis. (4) Conclusions: Uncomplicated and complicated appendicitis appear to have different pathophysiology and should be treated differently. The differentiation between uncomplicated and complicated appendicitis remains a diagnostic challenge.

A prediction nomogram for uncomplicated appendicitis and complicated appendicitis: A retrospective study

“…To make management choices, clinicians must rst diagnose appendicitis and then distinguish between simple and complex forms of the disease. Although scoring systems have the potential to increase the accuracy of diagnoses, they have yet to be proven to accurately differentiate between the severity of conditions [15]. The article establishes a simple and accurate scoring system for patients with pathologically con rmed acute appendicitis by collecting preoperative clinical data to distinguish between UA and CA.…”

Application and curative effect of laparoscopic purse-string sutures in the treatment of adult acute complicated appendicitis

“…Complicated appendicitis is not an exact anatomical concept, and there is presently no standard definition [ 4 ]. Rather, it is a clinical concept limited to surgeons.…”

Apendicite aguda complicada e não complicada - uma revisão abrangente sobre a fisiopatologia, manifestações clínicas, microbiota intestinal e sua relevância, diagnóstico clínico, diagnóstico imagiológico, tratamento, prognóstico e perspectivas futuras

“…Embora sua função fisiológica ainda não seja completamente compreendida, suspeita-se de sua possível participação em processos imunológicos. Com base nisso, Charles McBurney desenvolveu um método de Brazilian Journal of Health Review, Curitiba, v. 6, n. 4, p. 19233-19250, jul./aug., 2023 diagnóstico clínico para essa patologia, conhecido como ponto de McBurney, localizado entre o processo espinhoso ântero-superior direito e a cicatriz umbilical (KRZYZAK; MULROONEY, 2020, ZHENG et al, 2021KJETIL SØREIDE, 2022, CONSTANTIN et al, 2023.…”