Validity of predictive factors of acute complicated appendicitis

Abstract

BackgroundOur previous retrospective study revealed the three preoperative predictors of complicated appendicitis (perforated or gangrenous appendicitis), which are body temperature ≥37.4 °C, C-reactive protein ≥4.7 mg/dl, and fluid collection surrounding the appendix on computed tomography. We reported here an additional prospective study to verify our ability to predict complicated appendicitis using the three preoperative predictors and thus facilitate better informed decisions regarding emergency surgery during night or holiday shifts.MethodsWe prospectively evaluated 116 adult patients who underwent surgery for acute appendicitis from January 2013 to October 2014. Ninety patients with one or more predictive factors of complicated appendicitis underwent immediate surgery regardless of the time of patient’s presentation. Twenty-six patients had no predictive factors and thus were suspected to have uncomplicated appendicitis. Of the 26 patients, 14 who presented to our hospital during office hours underwent immediate surgery. The other 12 patients who presented to our hospital at night or on a holiday underwent short, in-hospital delayed surgery during office hours.ResultsAll patients with no predictive factors had uncomplicated appendicitis, whereas 37 %, 81 %, and 100 % of patients with one, two, or all three factors, respectively, were diagnosed with complicated appendicitis. The emergency operation rate decreased from 83 % before to 58 % after adopting this scoring system, but no significant differences in postoperative complication rates and hospitalization periods were observed.ConclusionsThe above-mentioned preoperative factors predictive of complicated appendicitis preoperatively are useful for emergency surgical decisions and reduce the burdens on surgeons and medical staff.

Combining Ultrasound with a Pediatric Appendicitis Score to Distinguish Complicated from Uncomplicated Appendicitis in a Pediatric Population

“…Gangrenous appendicitis is characterized by ischemic regions that cause gangrene of the appendix, while perforation of the appendix is determined by the loss of continuity of the appendix ( 13 ). The histopathology of phlegmonous appendicitis corresponds to uncomplicated appendicitis (AUA), while gangrenous appendicitis and perforation are classified as complicated appendicitis (ACA), as stated in the document ( 13 , 14 ).…”

Sonographic differentiation of complicated from uncomplicated appendicitis

“…25 In clinical settings the histological finding of phlegmonous appendicitis directly corresponds with uncomplicated courses (AUA), whereas gangrenous appendicitis and perforation are categorised as acute complicated appendicitis (ACA), as stated in the literature. 6,25 Correlations between ultrasound findings and histopathological results are visualised in Figure 2.…”

“…Early detection of complicated appendicitis including gangrene with or without perforation is crucial for timely application of special antibiotic regimens and for estimation of the optimal time point for surgery. 6 Furthermore, this kind of differentiation might even offer the possibility of different treatment options. Nowadays, acute appendicitis is the most common diagnosis of paediatric patients who undergo surgical treatment and patients still experience a remarkably high rate of postoperative complications, despite the fact that most of the procedures are performed objective: This study aims to differentiate acute uncomplicated and complicated appendicitis, by investigating the correlation between sonographic findings and histological results in different types of paediatric appendicitis.…”

“…23 However, these authors concentrated on the differentiation of perforated and non-perforated appendicitis, while current evidence suggests that complicated appendicitis is already given earlier in the pathophysiological process by the presence of transmural myonecrosis. 6 The present study aims to investigate ultrasound as a discriminatory tool to differentiate between acute uncomplicated appendicitis and acute complicated appendicitis. The outstanding importance of this paper is demonstrated by the extended number of exclusively paediatric and adolescent patients.…”

Paradigm shift in the diagnosis and therapy of acute appendicitis

“…Laboratory tests are performed routinely in most patients. Besides the white blood cell count, a systematic review showed that C-reactive protein level provides the highest diagnostic accuracy (8). Non-invasive, inexpensive, and easy to perform, the ultrasound scan also avoids radiation, but its results are examiner-and patient-dependent.…”