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The article presents a study on the magnetic resonance imaging (MRI) characteristics of a normal appendix in children to create a reference standard. Topics include the lack of literature describing the normal range of appearance of the pediatric appendix on MRI, the use of MRI to diagnose pediatric appendicitis to avoid exposing children to ionizing radiation of computerized tomography, and the use of Cohen kappa statistic and Spearman correlation coefficient to assess reader agreement on data.

Background Conservative approach for complicated appendicitis has been gradually adopted in children to decrease postoperative morbidity. The first aim of this study was to assess the efficacy of a second-line antibiotics enlarged on Pseudomonas aeruginosa and Enterococcus in case of poor clinical outcome after initial conservative approach for appendiceal mass and abscess. The second aim of this study was to identify predictive factors of failure of first-line antibiotics. Methods We performed a prospective review of all the cases of appendiceal mass or abscess managed at our institution between November 2007 and September 2011 after implementation of a conservative protocol including a second-line antibiotics in case of poor initial clinical outcome. Results A total of 64 consecutive patients were included. We observed a success in 46 patients after the first-line antibiotics and in 14 of the remaining patients after the second-line. The only predictive factor of failure of the first-line antibiotics was a shorter duration of symptoms before admission (p = 0.02). Laparoscopic appendectomy was performed in all the cases (emergency or interval procedure) with six postoperative complications and two conversions to open surgery. Conclusions A gradual adapted antibiotherapy in nonoperative management of appendiceal abscess and mass is effective. We found no relevant predictive factor of failure of the first-line antibiotics. [ABSTRACT FROM AUTHOR]

Introduction: The two-port laparoscopic appendectomy technique (TPLA) lays between the conventional three-port trocar procedure and single-port laparoscopic appendectomy surgery. During TPLA, the appendix is suspended with stitches, resulting in perforation risk and difficulty in exploration. Aim: We used a needle grasper in TPLA to hang and manipulate the appendix. Material and methods: Thirty-four patients (10 female, 24 male) who underwent TPLA between February 2015 and November 2015 were analyzed retrospectively for patient demographics, duration of operation, laparotomy or conventional laparoscopy necessity, drain use, complications, and hospital stay periods. The needle grasper was inserted at the right under the abdominal quadrant (McBurney point) without an incision to hang and manipulate the appendix. Results: The mean age was 25.19 ±8.464 years; the mean body mass index (BMI) was 23.50 ±3.246 kg/m2. ASA scores were 1 and 2. The operations were completed without any additional trocar in 34 patients. The mean operation time was 57.03 ±3.814 min. There were no intraoperative complications in any patients. Three patients required a drain; all were discharged after drain removal. Thirty-one patients were discharged on the 1st postoperative day; three patients with drains were discharged on the 2nd day. The mean hospital stay period was 1.18 ±0.535 days. Conclusions: Using the needle grasper, the appendix was held and suspended and the mesoappendix was cauterized and skeletonized successfully in TPLA. Inserting a needle grasper into the abdominal cavity at the McBurney point to manipulate the appendix helps and does not leave a visible scar. [ABSTRACT FROM AUTHOR]

To investigate which clinical, laboratory, and CT findings potentially facilitate the differential diagnosis between tubo-ovarian abscess (TOA) and periappendicular abscess (PAA), we retrospectively reviewed abdominal CT examinations and medical records for all women who presented to our medical center with unilateral right pelvic abscess formation who underwent CT evaluation from 2004-2014. A wide spectrum of clinical data and imaging findings were recorded. CT diagnoses were made in consensus by two experienced body radiologists blinded to the final diagnosis. Findings associated with the infections were compared using the chi-square (χ(2)) or the Fisher exact test. Ninety-one patients were included; 58 with PAA (mean age 46 years) and 33 with TOA (mean age 37 years). Pain on cervical motion (67 %) and vaginal discharge (21 %) were significantly more common in TOA; other clinical signs were similar. The presence of right ovarian vein entering the mass on CT had 100 % specificity and 94 % sensitivity to TOA. Distended right fallopian tube (79 %), mass posterior to mesovarium (76 %), contralateral pelvic fat stranding (55 %), and thickening of sacrouterine ligaments (55 %) were significantly more common in TOA. Positive "arrowhead sign" (91 %), mesenteric lymphadenopathy (85 %), small bowel wall thickening (55 %), fluid in the right paracolic gutter (50 %), and cecal wall thickening (48 %) were significantly more common in PAA;internal gas was revealed only in PAA (33 %). Distinct CT features can increase diagnostic certainty regarding the origin of right lower quadrant abscess in women. [ABSTRACT FROM AUTHOR]

INTRODUCTION: Early appendicectomy has been found to be a safe and better alternative for management of appendicular mass in various studies in adults, while very few studies report such advantages in the paediatric population. We conducted this study to assess the safety, efficacy and need of early laparoscopic appendicectomy (ELA) in child patients with appendicular mass. MATERIALS AND METHODS: All patients with appendicular mass who underwent ELA at our institute between September 2011 and August 2014 were retrospectively reviewed. Appendicular mass was defined as a right iliac fossa mass in a case of acute appendicitis, diagnosed by clinical, laboratory and radiological evaluation, and palpation under anaesthesia, the patient being subjected to laparoscopic treatment. RESULTS: Forty-eight (48) patients were confirmed to have appendicular mass intraoperatively and were included in the analysis. There were 30 males and 18 females, with ages ranging 7-13 years (mean 9 years). In the present study, appendicular complications included appendicular abscess (62.5%), gangrenous appendicitis (25%), sloughed-out appendix (8.33%) and appendicular perforation (4.16%). The average operative time was 72 min (range 45-93 min). One case (1.92%) required conversion to open procedure due to failure of identification of the appendicular base of a sloughed-out appendix. Post-operative complications were found in 4 (7.69%) patients, of whom 3 (5.76%) had minor wound infection at the umbilical port site and 1 (1.92%) had post-operative pelvic abscess, which was managed with percutaneous aspiration. DISCUSSION: ELA avoids misdiagnosis, treats complicated appendicitis at its outset, and avoids complications and/ or failure of non-operative treatment of a potentially lethal, diseased appendix. This approach is associated with minimal complications in experienced hands and is a safe and feasible option in children with appendicular mass. [ABSTRACT FROM AUTHOR]

Background: It remains difficult to distinguish between complicated appendicitis (CAP) and uncomplicated appendicitis (UAP). There is a paucity of studies utilizing inflammatory markers to stratify the severity of acute appendicitis. This study aimed to evaluate and demonstrate the potential clinical utility of inflammatory markers as adjuncts in distinguishing CAP and UAP. Methods: A comparative observational study was performed. Patients diagnosed with acute appendicitis were categorized as (a) complicated (necrosis, perforation, abscess) and (b) uncomplicated (inflamed, edematous). Hematological indices were combined to generate the following ratios: white cell lymphocyte ratio (WLR), white cell neutrophil ratio (WNR) and neutrophil lymphocyte ratio (NLR). Parameter accuracy was assessed using summary receiver operating characteristic (sROC) curves, classification and regression tree analysis and confusion matrix generation. Results: On sROC analysis, neutrophils (area under the curve (AUC) 0.79, p < 0.001), WLR (AUC 0.79, p < 0.001) and NLR (AUC 0.79, p < 0.001) were the most accurate parameters in distinguishing CAP and UAP. White cell count (WCC; AUC 0.76, p < 0.001) and C-reactive protein (AUC 0.75, p < 0.001) were less accurate. WCC >12.25 (sensitivity 70%, specificity 68%) and NLR >5.47 (sensitivity 78%, specificity 70%) were the most accurate in identifying CAP. Conclusion: Inflammatory marker cutoff points can be generated and utilized to differentiate between UAP and CAP. This may be useful when deciding between conservative and operative management. [ABSTRACT FROM AUTHOR]

Background: There has been no comparative study of the long-term oncological outcomes of appendiceal cancer and colon cancer. We hypothesized that the oncological outcome is worse in appendiceal cancer because perforation is more frequent than in colon cancer. Methods: Patients with stage IeIII were selected from 5046 patients with appendiceal or colon cancer, between September 2001 and June 2010. The 5-year disease-free survival (DFS) was the primary endpoint. Multivariate analyses with Cox proportional hazards model for DFS and logistic regression model for perforation were conducted. A matching model was used to compensate for the heterogeneity between groups. Results: The perforation rate was 44.7% in appendiceal cancer (n = 47), but 1.1% in colon cancer (n = 2828) (p = 0.001). The 5-year DFS rate was lower in appendiceal cancer than in colon cancer (57.9% vs. 85.2%, p = 0.001; matching model, 54.2% vs. 78.4%, p = 0.038), with a higher rate of peritoneal seeding (25.5% vs. 2.5%, p = 0.001; matching model, 24.0% vs. 4.0%, p = 0.007). Multivariate Cox regression showed that appendiceal cancer was an independent prognostic factor for poor DFS (hazard ratio = 2.602, 95% confidence interval = 1.26e5.35, p = 0.009), and logistic regression confirmed that appendiceal cancer was the risk factor associated with perforation (odds ratio = 66.265, 95% confidence interval = 28.21e155.61, p = 0.001). Conclusions: This study suggested that the long-term oncological outcomes are worse for appendiceal cancer than for colon cancer, attributed to higher perforation rate in appendiceal cancer. [ABSTRACT FROM AUTHOR]

Purpose: Although abdominal computed tomography (ACT) has high sensitivity and specificity in helping to detect appendicitis in pediatric patients, diagnostic challenges still exist for some cases despite undergoing ACT, and negative appendectomies still persist. The aim of this study was to elucidate some ACT findings that support true appendicitis for patients who had inconclusive preoperative ACT findings. Patients and methods: For the 49 patients whose preoperative ACT diagnoses were inconclusive (ten negative appendicitis; 39 true appendicitis), the ACT findings were retrospectively measured for the following features: appendiceal enlargement, presence of appendicolith or hyperdense materials in the appendix, periappendiceal fat inflammation, periappendiceal fluid collection, appendiceal wall thickening, appendiceal gas, and right lower quadrant lymphadenopathy. These features were compared between true appendicitis and negative appendicitis cases. Results: The presence of an enlarged appendix of diameter >8 mm or periappendiceal fat inflammation strongly correlated with true appendicitis, while the absence of appendiceal wall thickening or mesenteric lymphadenopathy correlated with negative appendicitis. Conclusion: If the ACT findings were inconclusive for patients suspected of having appendicitis, factors such as periappendiceal fat inflammation, an enlarged appendix, appendiceal wall thickening, and mesenteric lymphadenopathy should be cautiously assessed to discriminate true appendicitis from negative appendicitis. [ABSTRACT FROM AUTHOR]

Purpose: Catarrhal appendicitis (CA) could be treated effectively with antibiotics in some patients because of the milder inflammation associated with this form of appendicitis. Although several trials have compared surgery with antibiotic therapy for acute appendicitis (AA), the indications for antibiotic therapy remain controversial. Methods: The subjects of this study were 342 patients who underwent appendectomy at our hospital between January, 2000 and March, 2013. The patients were divided into two groups based on the severity of their appendicitis: Group A comprised patients with severe appendicitis and Group B comprised patients with CA. Statistical analyses were performed to assess the clinical features associated with CA. Results: Multivariate analysis of the eight clinical features correlated with CA according to univariate analysis revealed that the neutrophil to lymphocyte ratio (NLR) ( <5/>5), age ( <38/>38 years), fever ( <38/>38 °C), white blood cell count ( <11.5/>11.5 × 10/mm) and serum level of C-reactive protein ( <110/>110 mg/L) were significantly associated with CA. The NLR ( <5/>5) (OR 0.421; 95 % CI 0.218-0.811; P = 0.010) was the most useful predictor of CA, because the area under the ROC curve of NLR was the lowest of all these features. Conclusion: The preoperative NLR in patients undergoing appendectomy is closely associated with CA. [ABSTRACT FROM AUTHOR]

Background.Geographic variations in incidence of appendicitis and proportion of perforations suggest environmental or genetic etiological factors. We study incidence of appendicitis and proportion of perforations according to geographical origin in immigrants and international adoptees in Sweden.Methods.A cohort of 11,557,566 Swedish residents – 277,104 first- and 377,773 second-generation immigrants and 57,304 adoptees – was followed from 1988 till 2010. Differences in proportion of operation for perforated appendicitis and negative appendectomy and standardized incidence ratios (SIR) of perforated and non-perforated appendicitis associated with geographic origin was analyzed.Results.High incidence rates are seen in first- and second-generation immigrants from South America for perforated (SIR 1.58 and 1.81, respectively) and non-perforated appendicitis (SIR 1.18 and 1.22, respectively), and in adoptees from South America for non-perforated appendicitis (SIR 1.07). Low incidence rates are seen for perforated appendicitis in first-generation immigrants and adoptees from Asia (SIR 0.74 and 0.56, respectively), and for non-perforated appendicitis in immigrants from Africa and Asia (SIR 0.69 and 0.76 in first-generation, 0.51 and 0.74 in second-generation, respectively) and in adoptees from Asia (SIR 0.71). A high proportion of perforated appendicitis is associated with a low incidence rate of non-perforated appendicitis but no increase in the incidence rate of perforated appendicitis.Conclusions.The association of different incidence of appendicitis with geographic origin which remains over generations and is seen in adoptees suggest genetic etiologic factors. The proportion of perforation can be high without an increased incidence rate of perforation and is therefore an imperfect indicator of quality of care. [ABSTRACT FROM AUTHOR]

Teaching Point: The acute appendicitis in a context of Malone appendicostomy complication is very rare but can occur and may be challenging to diagnose due to its unusual position. [ABSTRACT FROM AUTHOR]

[Objectives] The aim was to analyze the effect of Salvia miltiorrhiza injection combined with laparoscopic reduction on the degree of appendix injury in intussusception. [Methods]Seventy-four children with intussusception who were treated in the Xuchang Municipal Hospital from August 2014 to August 2017 were randomly and evenly divided into two groups, control group and treatment group. The children in the control group were treated by laparoscopic reduction, and those in the treatment group were treated with S.miltiorrhiza injection combined with laparoscopic reduction. The clinical effect on intussusception in the children was compared between the two groups. [Results] Before treatment, no significant difference was founding serum NO level between the control and treatment groups(P > 0.05). On Day 1, 3 and 5 of treatment, the serum NO levels of the treatment group[(74.16 ± 6.81), (61.98 ± 4.77) and(54.76 ± 4.36) μmol/L] were significantly lower than those of the control group[(89.67 ± 6.34), (84.75 ± 5.21) and(71.95 ± 4.58) μmol/L](P < 0.05).After treatment, the TNF-α and IL-6 levels of the treatment group[(184.32 ± 10.67) and(332.16 ± 34.17) pg/m L] were significantly lower than those of the control group[(268.26 ± 12.74) and(438.23 ± 35.26) pg/m L](P < 0.05);and the Chiu score of the treatment group(2.34 ± 1.12) was also significantly lower than that of the control group(4.85 ± 1.67)(P < 0.05). [Conclusions]For children with intussusception, S.miltiorrhiza injection combined with laparoscopic reduction is effective in reducing serum NO level and reducing the degree of appendix injury, which is worthy of clinical application. [ABSTRACT FROM AUTHOR]

The article focuses on the radiologic appearance of appendiceal intussusception, known as the coiled spring sign. Topics discussed include the possible causes of appendiceal intussusception including inflammation or lead points due to endometriosis, mucocele, adenoma, adenocarcinoma, carcinoid, or an inverted appendiceal stump. Also mentioned is the use of double contrast enema to characterize this condition.

The article highlights the importance of surgical management of acute appendicitis. It also evaluates the rate of carcinoid of the appendix (AC) in patients. Data was used from the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) to identify 163,844 patients who received surgical intervention for acute appendicitis.

Key Clinical Message: We report a rare case of a cystic mass in an appendix in a patient who presented nausea, vomiting, and sharp pain in lower right abdomen and mimicking acute appendicitis. Although this entity is very rare, careful physical observation, imaging, and pathology can be helpful to make an accurate diagnosis. [ABSTRACT FROM AUTHOR]

Appendiceal neoplasms are uncommon and found in 1.6 per cent of appendicectomy specimens. Schwannomas arising from the appendix are of significant rarity, with only a few previously‐reported cases. In this study, we present the case of a 31‐year‐old man who underwent a laparoscopic appendicectomy and was found to have an appendiceal schwannoma. In the present study, we review the literature of this rare condition, which serves to highlight the potential for appendiceal neoplasia to occur in a macroscopically‐normal appendix. Furthermore, it emphasizes the potential risk of missed appendiceal neoplasia as a sequelae of nonoperative management of suspected appendicitis. [ABSTRACT FROM AUTHOR]

Objectives: To study mean platelet volume (MPV) in acute appendicitis and its correlation with leukocyte count. Study Design: Case control study Place and Duration: Department of Surgery, Liaquat University of Medical and Health Sciences Jamshoro/Hyderabad from January 2013 to February 2014. Subjects and Methods: Subjects with clinical suspicion of acute appendicitis were selected according inclusion and exclusion criteria. A sample of 49 acute appendicitis patients and 37 controls were studied. The Blood samples were collected in sodium citrate vacutainers and processed on Sysmex KX 21 analyzers. The main analysis was the comparison of the difference of MPV between acute appendicitis and controls. Data was analyzed on SPSS version 21.0 by student's t-test, Chi-square test and Pearson's correlation (r) was used to evaluate association of MPV with platelet counts and leukocytes. A p-value of ≤0.05 was taken significant. Results: The mean platelet volume and leukocytes were significantly elevated in patients with acute appendicitis. MPV and leukocytosis in controls and cases were noted as 7.93±2.1 vs. 9.10±2.9fl (p=0.0001) and 6980±120 vs. 13980±340 μL-1 respectively. MPV was positively correlated with leukocytosis (r=0.419) (p=0.0001), while Platelets showed a negative correlation. Conclusion: Elevated MPV and leukocytosis are observed in acute appendicitis. MPV may be exploited for clinical diagnosis of acute appendicitis but in a proper clinical context along with leukocytosis. [ABSTRACT FROM AUTHOR]

Background: Ultrasonography is considered the most appropriate initial imaging study in the evaluation of acute appendicitis in children but has recently come under criticism with reports of low specificity and high indeterminate study rates, particularly when used in obese patients and patients early in the course of their disease, or when performed by sonographers with limited experience.Objective: To (1) assess the impact of patient factors (gender, age, body mass index, and symptom duration) and system factors (call status or year of exam) on pediatric appendiceal US accuracy and indeterminate study rate, (2) assess the impact of indeterminate study results on follow-up CT and negative laparotomy rates and (3) present strategies to reduce the rate of indeterminate US studies and improve accuracy.Materials and Methods: We retrospectively reviewed all US reports performed for the assessment of acute appendicitis in children <18 years old at Mayo Clinic Rochester from January 2010 to June 2014.Results: A total of 790 US examinations were performed in 452 girls (57%) and 338 boys (43%). The prevalence of appendicitis was 18.5% (146/790). There were 109 true-positive, 440 true-negative, 17 false-positive, 6 false-negative, 218 equivocal and 41 technically inadequate US studies. A definitive interpretation was made in 72% of the studies, with an accuracy, sensitivity and specificity of 0.960, 0.948 and 0.963, respectively. No patient or system factors significantly affected US accuracy. Indeterminate studies (28%) had significantly higher CT utilization (46% vs. 11%) and normal appendectomy rates (6.9% vs. 3.5%).Conclusion: US should be the initial imaging study of choice for pediatric appendicitis. When a definitive interpretation was given, the accuracy was 96%, was independent of patient and system factors and resulted in reduced follow-up CTs and negative laparotomies. Accuracy can be increased by requiring the presence of periappendiceal inflammatory changes prior to interpreting a mildly distended appendix as positive for acute appendicitis. The indeterminate study rate can be reduced by not requiring visualization of the normal appendix for the exclusion of acute appendicitis. [ABSTRACT FROM AUTHOR]

Background: To facilitate consistent, reliable communication among providers, we developed a scoring system (Appy-Score) for reporting limited right lower quadrant ultrasound (US) exams performed for suspected pediatric appendicitis.Objective: The purpose of this study was to evaluate implementation of this scoring system and its ability to risk-stratify children with suspected appendicitis.Materials and Methods: In this HIPAA compliant, Institutional Review Board-approved study, the Appy-Score was applied retrospectively to all limited abdominal US exams ordered for suspected pediatric appendicitis through our emergency department during a 5-month pre-implementation period (Jan 1, 2013, to May 31, 2013), and Appy-Score use was tracked prospectively post-implementation (July 1, 2013, to Sept. 30,2013). Appy-Score strata were: 1 = normal completely visualized appendix; 2 = normal partially visualized appendix; 3 = non-visualized appendix, 4 = equivocal, 5a = non-perforated appendicitis and 5b = perforated appendicitis. Appy-Score use, frequency of appendicitis by Appy-Score stratum, and diagnostic performance measures of US exams were computed using operative and clinical finding as reference standards. Secondary outcome measures included rates of CT imaging following US exams and negative appendectomy rates.Results: We identified 1,235 patients in the pre-implementation and 686 patients in the post-implementation groups. Appy-Score use increased from 24% (37/155) in July to 89% (226/254) in September (P < 0.001). Appendicitis frequency by Appy-Score stratum post-implementation was: 1 = 0.5%, 2 = 0%, 3 = 9.5%, 4 = 44%, 5a = 92.3%, and 5b = 100%. Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were 96.3% (287/298), 93.9% (880/937), 83.4% (287/344), and 98.8% (880/891) pre-implementation and 93.0% (200/215), 92.6% (436/471), 85.1% (200/235), and 96.7% (436/451) post-implementation - only NPV was statistically different (P = 0.012). CT imaging after US decreased by 31% between pre- and post-implementation, 8.6% (106/1235) vs. 6.0% (41/686); P = 0.048). Negative appendectomy rates did not change (4.4% vs. 4.1%, P = 0.8).Conclusion: A scoring system and structured template for reporting US exam results for suspected pediatric appendicitis was successfully adopted by a pediatric radiology department at a large tertiary children's hospital and stratifies risk for children based on their likelihood of appendicitis. [ABSTRACT FROM AUTHOR]

Introduction: Acute appendicitis is the most common cause of an acute abdomen requiring surgery, the clinical presentation is typical in 50% of the cases, but the decision to explore the patient can sometimes be challenging. The diagnosis is based on history, clinical examination, and few laboratory investigations. To help the surgeon make diagnosis with certainty and reduce negative laparotomy rate, a number of clinical scoring systems are in vogue. The present study was undertaken to evaluate the Raja Isteri Pengiran Anak Saleha Appendicitis (RIPASA) score in the diagnosis of acute appendicitis. Materials and Methods: A prospective study was undertaken among 100 cases presenting with signs and symptoms suggestive of acute appendicitis. Validity of RIPASA score as a diagnostic test for appendicitis was established by calculating its sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) along with 95% confidence intervals (CIs), using intraoperative diagnosis confirmed by histopathology as gold standard. Results: RIPASA had sensitivity of 82.61% (95% CI 72.02, 89.76) and specificity of 88.89% (95% CI 67.2, 96.9). It had a PPV of 96.61% (95% CI 88.46, 99.07), NPV of 57.14% (95% CI 39.07, 73.49), and a diagnostic accuracy rate of 83.91% (95% CI 74.78, 90.17). Conclusion: The RIPASA score is a simple scoring system with a reasonable sensitivity and specificity for the diagnosis of acute appendicitis. [ABSTRACT FROM AUTHOR]

The article discusses the study of Acute appendicitis (AA) which is one of the major reasons for emergency surgeries. The patients with AA reports with increased morbidity and mortality rates, reason being the perforation of appendix. Study of patients with perforated and non-perforated was done and were compared on their appendix location, length and other physical features. It reported with the result of wall thickness, length and root diameter as the perforation's risk factors In AA.

Diverticular disease of the appendix is rare and is usually diagnosed during surgery. We report a case of a 50-year-old man who presented to the emergency department with right lower quadrant pain of 1-day duration. A preoperative diagnosis of appendiceal diverticulitis was made by computed tomography of the abdomen. The patient underwent emergency laparoscopic appendectomy, which confirmed the diagnosis. [ABSTRACT FROM AUTHOR]

Background: Artificial neural networks is one of pattern analyzer method which are rapidly applied on a bio-medical field.Objective: The aim of this research was to propose an appendicitis diagnosis system using artificial neural networks (ANNs).Methods: Data from 801 patients of the university hospital in Dongguk were used to construct artificial neural networks for diagnosing appendicitis and acute appendicitis. A radial basis function neural network structure (RBF), a multilayer neural network structure (MLNN), and a probabilistic neural network structure (PNN) were used for artificial neural network models. The Alvarado clinical scoring system was used for comparison with the ANNs.Results: The accuracy of the RBF, PNN, MLNN, and Alvarado was 99.80%, 99.41%, 97.84%, and 72.19%, respectively. The area under ROC (receiver operating characteristic) curve of RBF, PNN, MLNN, and Alvarado was 0.998, 0.993, 0.985, and 0.633, respectively.Conclusions: The proposed models using ANNs for diagnosing appendicitis showed good performances, and were significantly better than the Alvarado clinical scoring system (p < 0.001). With cooperation among facilities, the accuracy for diagnosing this serious health condition can be improved. [ABSTRACT FROM AUTHOR]

The aim of the study is to evaluate the diagnostic accuracy of noncontrast CT in detecting acute appendicitis. Prospective studies in which noncontrast CT was performed to evaluate acute appendicitis were found on PubMed, EMBASE, and Cochrane Library. Pooled sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, and diagnostic odds ratio were assessed. The summary receiver-operating characteristic curve was conducted and the area under the curve was calculated. Seven original studies investigating a total of 845 patients were included in this meta-analysis. The pooled sensitivity and specificity were 0.90 (95% CI: 0.86-0.92) and 0.94 (95% CI: 0.92-0.97), respectively. The pooled positive likelihood ratio, negative likelihood ratio, and diagnostic odds ratio was 12.90 (95% CI: 4.80-34.67), 0.09 (95% CI: 0.04-0.20), and 162.76 (95% CI: 31.05-853.26), respectively. The summary receiver-operating characteristic curve was symmetrical and the area under the curve was 0.97 (95% CI: 0.95-0.99). In conclusion, noncontrast CT has high diagnostic accuracy in detecting acute appendicitis, which is adequate for clinical decision making. [ABSTRACT FROM AUTHOR]

The study objective was to find factors predictive of ultrasound visualization of the appendix in patients with suspected appendicitis. A total of 238 consecutive adult patients (178 women, mean age 38.9 y, weight 58.2 kg, body mass index 22.7) who underwent appendiceal ultrasound from January to December 2011 were included. Appendicitis was confirmed in 171 patients (171/238, 71.9%). Ultrasound sensitivity, specificity and accuracy were 64%, 90% and 71%, respectively. The appendix was visualized at ultrasound in 126 patients (group 1) and not visualized in 112 patients (group 2). Group 1 had a lower body mass index, higher pain score and higher Alvarado score. The chances of visualizing the appendix in patients with body mass indexes ≤22, pain scores ≥6, and Alvarado scores ≥6 were 2.3, 2.9, and 3.8 times higher than those of their counterparts, respectively. Therefore, in patients with these factors, the use of ultrasound may be beneficial in the diagnosis of acute appendicitis. [ABSTRACT FROM AUTHOR]

In children presenting to hospital with gastrointestinal symptoms, diseases such as intussusception and acute appendicitis require particular attention and careful examination. Early diagnosis and proper treatment are important because of possible severe complications such as peritonitis and death. Intussusception and appendicitis share similar clinical manifestations. More importantly, the presence of acute appendicitis together with intussusception in children is very rare. We describe an interesting case of a 38-month-old boy who presented with abdominal pain in the right lower quadrant. His vital signs were stable and laboratory test findings showed no specific alterations. We detected tenderness in the right lower quadrant. A computed tomography scan showed an ileocolic intussusception with no strangulation and diffuse wall thickening of the appendix trapped within the intussusception. The patient underwent an appendectomy and manual reduction. [ABSTRACT FROM AUTHOR]

The article reports on the case of a 56-year-old male patient diagnosed with acute appendicitis. Topics discussed include the symptoms exhibited by the patient, a comparison between appendectomy and antibiotics-first strategies in addressing appendicitis and the types of patients who are suitable for the antibiotics-first strategy. Also discussed are the areas of uncertainty when it comes to determining whether appendectomy is the best way to manage appendicitis.

Objective: To evaluate whether mandatory imaging is an effective strategy in suspected appendicitis for reducing unnecessary surgery and costs. Methods: In 2010, guidelines were implemented in The Netherlands recommending the mandatory use of preoperative imaging to confirm/refute clinically suspected appendicitis. This retrospective study included 1,556 consecutive patients with clinically suspected appendicitis in 2008-2009 (756 patients/group I) and 2011-2012 (800 patients/group II). Imaging use (none/US/CT and/or MRI) was recorded. Additional parameters were: complications, medical costs, surgical and histopathological findings. The primary study endpoint was the number of unnecessary surgeries before and after guideline implementation. Results: After clinical examination by a surgeon, 509/756 patients in group I and 540/800 patients in group II were still suspected of having appendicitis. In group I, 58.5% received preoperative imaging (42% US/12.8% CT/3.7% both), compared with 98.7% after the guidelines (61.6% US/4.4% CT/ 32.6% both). The percentage of unnecessary surgeries before the guidelines was 22.9%. After implementation, it dropped significantly to 6.2% ( p<0.001). The surgical complication rate dropped from 19.9% to 14.2%. The average cost-per-patient decreased by 594 € from 2,482 to 1,888 € (CL:−1081; −143). Conclusion: Increased use of imaging in the diagnostic work-up of patients with clinically suspected appendicitis reduced the rate of negative appendectomies, surgical complications and costs. Key Points: • The 2010 Dutch guidelines recommend mandatory imaging in the work-up of appendicitis. • This led to a considerable increase in the use of preoperative imaging. • Mandatory imaging led to reduction in unnecessary surgeries and surgical complications. • Use of mandatory imaging seems to reduce health care costs. [ABSTRACT FROM AUTHOR]

Background: Morgagni hernia is a congenital diaphragmatic defect that rarely presents with symptomatic findings in adults. The presence of one diaphragmatic defect may decrease the occurrence of a separate diaphragmatic defect. Appendicitis may be a unique presentation of incarcerated bowel in a Morgagni defect. Case presentation: Review of recent literature and presentation of a patient with Morgagni defect. Only five cases of simultaneous Morgagni hernia and paraesophageal hernia have been described in the English-language literature since 1958. Here, we report the first case of acute appendicitis within an incarcerated right Morgagni hernia in a 76-year-old patient who also had a paraesophageal hernia. Conclusion: This case illustrates that there is no role for watchful waiting in the management of Morgagni Defects when diagnosed in adult patients. [ABSTRACT FROM AUTHOR]

Perforated appendicitis has major implications on patient care. The ability of computed tomography (CT) scan to distinguish perforation in the absence of phlegmon or abscess is unknown. The purpose of this study is to assess the use and accuracy of CT scans in diagnosing perforated appendicitis without phlegmon or abscess. A retrospective chart review of 102 patients who underwent appendectomy from 2011 to 2013 was performed. Patient demographics and operative and postoperative course were recorded. Two radiologists were then blinded to operative findings and CT scans reread and results correlated. Findings on CT scan were also analyzed for correlation with perforation. Univariate and multivariate statistical analysis was performed. Of the 102 patients, 49 were perforated and 53 nonperforated. Analysis of patient populations demonstrated patients with perforation were significantly older (45 vs 34 years, P = 0.002), had longer operative times (132 vs 81 minutes, P = 0.001), and longer length of stay (8.2 vs 1.5 days, P < 0.001). Nineteen perforations (37%) were correctly diagnosed by CT scan. The sensitivity of CT scan to detect perforation was 38 per cent, specificity 96 per cent, and positive predictive value of 90 per cent. After multivariate analysis of significant variables, three were demonstrated to significantly correlate with presence of perforation: presence of extraluminal air (odds ratio [OR], 28.9; P = 0.02); presence of intraluminal fecalith (OR, 5.7; P = 0.03); and wall thickness greater than 3 mm (OR, 3.2; P = 0.02). CT scan has a low sensitivity for diagnosing perforated appendicitis without abscess or phlegmon. Presence of extraluminal air bubbles, increased wall thickness, and intraluminal fecalith should increase suspicion for perforation and are highly correlated with outcomes after appendectomy. [ABSTRACT FROM AUTHOR]

Background: Endoscopic retrograde appendicitis therapy (ERAT) is a new procedure for the treatment of acute uncomplicated appendicitis. The aim of the study was to review the clinical outcomes of ERAT and further examine its effectiveness and safety. Methods: The study was performed on patients who underwent ERAT for acute uncomplicated appendicitis at three tertiary hospitals in China from December 2009 to May 2013. Patient demographics, technique aspects of the ERAT procedures, clinical success (resolution of symptoms and normalization of laboratory tests), time until resumption of diet, and hospital stay were analyzed, and complications and recurrence were followed up. Results: Forty-one patients were entered, among which 34 patients were definitely diagnosed as having acute uncomplicated appendicitis; in 7 patients, acute appendicitis was excluded by endoscopic retrograde appendicography. Thirty-three patients completed ERAT except one patient who failed appendiceal cannulation. Abdominal pain resolved immediately in 32 patients, and clinical success rate was 97 %. There was one failure case (3 %) that complicated perforation after 48 h received emergency appendectomy. The median follow-up period was 12 months (IQR = 9-23 months). During follow-up, there were no long-term complication; 2 patients (6.2 %) had recurrent abdominal pain and received appendectomy (one had a histologically normal appendix). Conclusions: ERAT is an effective method to diagnose and treat acute uncomplicated appendicitis. Multicenter prospective clinical trials are needed to confirm its utility and place in the management of suspected acute appendicitis [ABSTRACT FROM AUTHOR]

Aim Single-incision laparoscopic surgery ( SILS) has been proposed as the next step in minimally invasive surgery for appendicectomy. Previous reviews have summarized the results of low-evidence comparative studies, suggesting that the two approaches are comparable in terms of outcomes but showing the need for randomized controlled trials ( RCTs). This review offers a meta-analyses of RCTs on this topic to evaluate the safety and efficacy of single-incision laparoscopic appendectomy ( SILA). Method A comprehensive research of electronic databases was performed. Primary outcomes (overall and access-specific morbidity) were designated as safety issues. Secondary outcomes were pain, cosmesis, operative time, conversion rate and length of hospital stay. Results After exclusions, five RCTs satisfied the inclusion criteria. They included a total of 761 patients [379 SILA and 382 conventional three-port laparoscopic appendectomies ( CLA)]. No significant differences were found in overall morbidity, early wound morbidity or length of stay between SILA and CLA. Cosmesis and pain were not comparable due to different scales and time records. Conclusions on the incisional hernia rate were not reliable due to short follow-up periods. Conclusion SILA can be considered an acceptable alternative to CLA in the treatment of acute appendicitis, but an economic evaluation of the various techniques for single access must be performed before its widespread clinical introduction. Better-designed RCTs are necessary to define a population in which SILA could have major benefits. [ABSTRACT FROM AUTHOR]

Background: Appendicectomy (AE), the most frequent emergency surgical procedure, can be performed as a transvaginal hybrid natural orifice translumenal endoscopic surgery (NOTES) technique (TVAE). The question of feasibility also arises in cases of advanced inflammation with perforation. Material and methods: Since May 2012 all female patients with suspected acute appendicitis were offered a TVAE as an alternative to the standard procedure. Preoperative, intraoperative and postoperative parameters were registered prospectively. Results: Until October 2013 a total of 13 TVAEs had been performed. The median age of the patients was 41 years (range 20-76 years), median BMI was 23.1 (range 18.1-28.3 kg/m) and the American Society of Anesthesiologists score (ASA) distribution (I/II/≥ III) was 8/5/0. Histology revealed three cases of perforated, one hemorrhagic necrotizing and seven phlegmonous appendicitis. Furthermore, there were two findings without inflammation, namely one neurogenic appendicopathy and one neuroendocrine tumor. For the three patients with perforated appendicitis, there was a trend for higher age (67.0 years versus 33.5 years, p = 0.063) and a higher C-reactive protein (CRP) level on admission (134.4 mg/l versus 26.4 mg/l, p = 0.043). Also, procedural time and hospital stay were longer (64 min versus 47 min, p = 0.033 and 14 days versus 3 days, p = 0.004, respectively). The former was mostly due to more extensive intraoperative flushing (volume 3000 ml versus 500 ml, p = 0.013 and duration 13 min versus 2 min, p = 0.011). None of the cases required conversion but two of the three postoperative complications occurred in patients with perforation, which also resulted in the longer hospital stay. Conclusion: Technically, TVAE seems feasible also in cases of perforated appendicitis. However, in these cases procedural time is prolonged due to more extensive flushing. Whether or not the longer hospital stay can be attributed to the perforation or if TVAE results in a higher rate of complications in cases of perforated appendicitis needs further evaluation. [ABSTRACT FROM AUTHOR]

Herbal products (HPs) are widely used as pharmaceutical and neutraceutical agents in India. The existing Pharmacovigilance Programme of India (PvPI) encourages reporting of adverse events related to HPs to monitor their safety. To analyze the reported adverse reactions suspected with the use of HPs all reports submitted to the National Coordination Centre (NCC) for PvPI during the period July 2011–December 2013 were assessed on the probability of a causal link between the use of the medication and the reported adverse reaction. An overview was compiled of all reports relating to severe adverse reactions. The NCC-PvPI database contained 39 reports of suspected adverse reactions to HPs in which 16 of them were classified as serious, 12 were non serious and 11 were unassessable. The cases were further categorized by system organ classification (SOC) and it was found that 52.5% were related to skin and appendages disorders. The suspected HPs were Gudmar Ameda, Shankhpushpi, Mahavat Vidhwansan, Dashmool Kwath, Shemar Yesaka, Melas cream, Senna Extract, Aloe Vera, Mustard oil, Digitalis, Garlic, Menthol and Turmeric. Causality assessment as per the WHO scale revealed that five cases were probable/likely, 17 were possible, one was unlikely and the rest of them were unassessable or blank. Healthcare providers and consumers must be educated to ensure the safe use of herbal products. Also rigorous monitoring to ensure the safe use of HPs through PvPI is essential to safeguard public health. [ABSTRACT FROM AUTHOR]

Accurate diagnosis of acute appendicitis (AA) is still a problem and is not always easy, even for experienced surgeons. Studies have shown that 20 to 30% of the appendices removedwere normal. Therefore, various scoring systems have been developed to aid in the diagnosis of doubtful cases and reduce the number of unnecessary appendectomies. The aim of this study was to assess the diagnostic value of different scoring systems in acute appendicitis. Material and methods. The study involved 94 patients who underwent laparotomy due to suspected acute appendicitis. Medical examination at hospital admission was performed by a resident and a general surgery specialist. The probability of AA was evaluated using six different scoring systems: Alvarado, Fenyo, Eskelinen, Ohman, Tzankis, and RIPASA. The resident calculated the results in individual systems. The decision to perform the operation was taken by a specialist surgeon who did not know the results. Results. Normal appendix was removed in 26% of cases. Eskelinen, RIPASA and Alvarado systems showed highest sensitivity (99%, 88% and 85%, respectively). Tzankis and Fenyo systems showed highest specificity (62% and 50%, respectively). Conclusions. Our study has shown limited value of scoring systems for the diagnosis of acute appendicitis. The systems may improve diagnostic accuracy as they require obtaining a more detailed medical history, and making a more thorough and organized data analysis. However, the scoring systems should be treated only as an aid to diagnosis [ABSTRACT FROM AUTHOR]

Background: Iterative reconstruction technique has been proposed as a means of reducing patient radiation dose in pediatric CT. Yet, the effect of such reductions on diagnostic accuracy has not been thoroughly evaluated. Objective: This study compares accuracy of diagnosing pediatric acute appendicitis using contrast-enhanced abdominopelvic CT scans performed with traditional pediatric weight-based protocols and filtered back projection reconstruction vs. a filtered back projection/iterative reconstruction technique blend with reduced volume CT dose index (CTDI). Materials and methods: Results of pediatric contrast-enhanced abdominopelvic CT scans done for pain and/or suspected appendicitis were reviewed in two groups: A, 192 scans performed with the hospital's established weight-based CT protocols and filtered back projection reconstruction; B, 194 scans performed with iterative reconstruction technique and reduced CTDI. Reduced CTDI was achieved primarily by reductions in effective tube current-time product (mAs) and tube peak kilovoltage (kVp). CT interpretation was correlated with clinical follow-up and/or surgical pathology. CTDI, size-specific dose estimates (SSDE) and performance characteristics of the two CT techniques were then compared. Results: Between groups A and B, mean CTDI was reduced by 45%, and mean SSDE was reduced by 46%. Sensitivity, specificity and diagnostic accuracy were 96%, 97% and 96% in group A vs. 100%, 99% and 99% in group B. Conclusion: Accuracy in diagnosing pediatric acute appendicitis was maintained in contrast-enhanced abdominopelvic CT scans that incorporated iterative reconstruction technique, despite reductions in mean CTDI and SSDE by nearly half as compared to the hospital's traditional weight-based protocols. [ABSTRACT FROM AUTHOR]

Mucinous lesions of the appendix and ovary are commonly encountered in routine practice. There are several published classification schemes for appendiceal mucinous neoplasms with resultant inconsistent use of terms and clinical doubt. While nomenclature is more settled with regards to ovarian mucinous neoplasms, the difficulty here lies with distinguishing primary from secondary mucinous tumours. This review highlights the terminology and nomenclature for appendiceal mucinous tumours, the relationship with ovarian mucinous neoplasms and pseudomyxoma peritonei, and the features that assist in separating primary from secondary ovarian mucinous tumours. [ABSTRACT FROM AUTHOR]

Despite increasing reports that Blastocystis infection is associated with digestive symptoms, its pathogenicity remains controversial. We report appendicular peritonitis in a 9-year-old girl returning to France from Morocco. Only Blastocystis parasites were detected in stools, appendix, peritoneal liquid, and recto-uterine pouch. Simultaneous gastroenteritis in 26 members of the child's family suggested an outbreak. [ABSTRACT FROM AUTHOR]

Acute appendicitis is the most common acute surgical condition; making appendectomy the most commonly performed emergency surgical procedure in the world. Anomalies of the appendix are relatively uncommon. However, their presence may alter the course of pre-operative diagnosis and the surgical treatment provided, leading to medico-legal issues in certain cases as well. We hereby present the case of a 17 year-old female who had the suggestive signs, symptoms and investigations of appendicular lump. She was managed according to the Ochsner-Sherren regimen and then underwent interval open appendectomy 6 weeks later. During the procedure, the findings of a 5 cm long appendix were noted. The base of the appendix was attached to the caecum, however there was complete mucosal discontinuity between the base and the remaining portion of the appendix. A fibrous strand connected the two blind ending parts together. After thorough literature search, the authors concluded that this is only the fourth reported case of appendicular atresia ever to have been reported. Considering the rarity of this finding we feel this could be of valuable interest to surgeons and readers alike [ABSTRACT FROM AUTHOR]

Double localization of tuberculosis is a rare finding among immunocompetent patients. Intestinal tuberculosis is a rare condition and its diagnosis remains a challenge to the physician. We present the case of a 21 year old male patient with intestinal tuberculosis in which the first manifestation was an acute appendicitis. Ultrasound findings were an abscessed appendicular mass. The surgical intervention found a granulomatous aspect of the peritoneum and total necrosis of the appendix. Histopathological examination confirmed the diagnosis and the pulmonary radiography detected the concomitant pulmonary tuberculosis. [ABSTRACT FROM AUTHOR]

We report a case of an extremely rare inflammatory condition of appendix, malakoplakia, in a 22 years old female, who presented with chronic abdominal pain. The clinicopathological features of this condition will be discussed, along with a review of the literature. [ABSTRACT FROM AUTHOR]

Tumors of the appendix are extremely rare and constitute about 0.4% of all tumors of the gastrointestinal tract. The most common benign neoplasm is mucinous cystadenoma, which can be found in 0.6% of all excised appendices and it rarely produces any symptoms. We present the case of a female patient who underwent surgery in the Department of Surgery due to suspicion of a periappendicular abscess. On the postoperative pathology study, the diagnosis of a tumor of the appendix (mucinous cystadenoma) was made. Mucinous cystadenoma is rarely included in the differential diagnosis of a non-specific abdominal pain accompanied by non-characteristic laboratory test results and imaging studies. There are no unequivocal guidelines and algorithms of managing this disease. Long-term prognosis is good in the case of a benign tumor. [ABSTRACT FROM AUTHOR]

Appendectomy is one of the most common emergency surgical procedures. Stump appendicitis is well-recognised entity has been described in the literature. Still, with recent advance in imaging technique, it remains as a clinical challenge for diagnosis and effective treatment. We present a case of 13-year-old boy who underwent laparoscopic appendectomy 3 months back and presented to us with acute abdomen associated with vomiting and fever. Imaging revealed the presence of a tubular residual inflamed tip of the appendix of size 4 cm laying in paracaecal position with approximately 50cc purulent collection around it. Subsequently, the patient underwent successful laparoscopic completion appendectomy with uneventful postoperative recovery. Histopathological examination confirmed that resected structure as an inflammatory residual appendix. For our knowledge, after an extensive search of English literature, no study had described about laparoscopic completion appendectomy for residual tip appendicitis. We authors hereby would like to emphasise the importance of complete removal of appendix not only stump part but also tip, especially in certain locations such as paracaecal, retrocaecal and subhepatic. Laparoscopy can be an option for the management of these patients, in selected cases, and with available expertise. [ABSTRACT FROM AUTHOR]

Both mucinous cystadenoma of the appendix and intestinal schistosomiasis are rare lesions. We report a rare case of simultaneous giant mucinous cystadenoma of the appendix and intestinal schistosomiasis. A 64-year-old man from China presented with a one-year history of pain in the right lower quadrant of the abdomen. There were no other pertinent historical findings, other than schistosomiasis. Imaging showed a large, tubular, mesenteric cystic structure extending downwards from the inferior wall of the cecum. Right hemicolectomy was performed for the appendiceal tumor. The final pathological diagnosis was mucinous cystadenoma with calcified Schistosome eggs within the mucosa and submucosa of the appendix, small intestine, colon, and lymph nodes. We deduced that the pathogenesis of appendiceal mucinous cystadenoma in our case was Schistosome eggs causing luminal obstruction, finally resulting in intraluminal accumulation of mucoid material. Postoperatively, the patient recovered well. [ABSTRACT FROM AUTHOR]

The increasing use of computed tomography (CT) in acute appendicitis makes recognising the radiological hallmarks of the condition and its mimics vital. The differential diagnosis includes both appendiceal and nonappendiceal pathologies. The correlation between pre-appendectomy CT and post-appendectomy histopathology was audited retrospectively. Cases of clinico-histopathological discrepancy underwent blind peer-review, and possible improvements were discussed in the context of the medical literature. A grade for discrepancy was given based on the RADPEER scoring system, and interesting or discrepant cases were examined more closely to identify targets for education. Of the 199 procedures, 4 appendectomies were negative (histologically normal), 182 were positive (primary appendicitis) and 13 were incidental (another primary process caused inflammation). The positive predictive value for pre-appendectomy CT was 91.5 %, and the negative appendectomy rate was 2 %. There were many secondary pathologies, including neoplasia, tuberculosis and endometriosis. Although no CT reports missed a diagnosis that should be made 'almost all of the time' and in 96 % of cases, the second, blinded radiologist agreed with the initial assessment, in 3 cases, a missed diagnosis altered clinical management; 2 were 'understandable' misses but 1 was not. In five cases, a discrepancy was 'understandable' but clinically insignificant. Overall, in comparison to the medical literature, the degree of clinico-histopathological correlation was good. Although identifying areas for improvement was challenging, after a pictorial review of four cases and a discussion of the medical literature, we present our audit results and some valuable learning points for use in the CT assessment of suspected acute appendicitis. [ABSTRACT FROM AUTHOR]

Objective To compare outcomes and management practices among pregnant and nonpregnant women with acute appendicitis. Design Population-based matched cohort study. Setting United States of America. Sample A total of 7114 women with appendicitis among 7 037 386 births. Methods Logistic regression analyses to calculate the odds ratio ( OR) and corresponding 95% confidence intervals (95% CIs) for variables and outcomes of interest. Main outcome measures Maternal morbidities associated with appendicitis; management practices for pregnant and age-matched nonpregnant women with appendicitis. Results There was an overall incidence of 101.1 cases of appendicitis per 100 000 births. Appendicitis was diagnosed in 35 570 nonpregnant women during the corresponding time frame. Peritonitis occurred in 20.3% of pregnant women with appendicitis, with an adjusted OR of 1.3 (95% CI 1.2-1.4) when compared with nonpregnant women with appendicitis. In pregnancy, there was an almost two-fold increase in sepsis and septic shock, transfusion, pneumonia, bowel obstruction, postoperative infection and length of stay >3 days. Whereas 5.8% of appendicitis cases among pregnant women were managed conservatively, they were associated with a considerably increased risk of shock, peritonitis and venous thromboembolism as compared to surgically managed cases. Conclusions Compared with nonpregnant women, pregnant women with acute appendicitis have higher rates of adverse outcomes. Conservative management should be avoided given the serious risk of adverse outcomes in pregnancy. [ABSTRACT FROM AUTHOR]

While acute appendicitis is a common and important clinical problem, a variety of other disease processes can affect the appendix. Simple and perforated appendicitis, tip appendicitis, and stump appendicitis share a common clinical presentation including anorexia, right lower quadrant pain, and fever. By imaging, most cases of acute appendicitis exhibit luminal dilation, wall thickening, and periappendiceal inflammatory stranding. In tip appendicitis, these changes are isolated to the distal appendix, often with an obstructing appendicolith. Perforated appendicitis can exhibit mural discontinuity, periappendiceal abscess, and/or extraluminal appendicoliths. After appendectomy, the appendiceal remnant or 'stump' can become inflamed, often necessitating repeat surgery. Inflammatory bowel disease can involve the terminal ileum, secondarily involving the appendix, or may primarily involve the appendix. Patient symptoms can be chronic in such cases, and mucosal hyperenhancement is a pronounced imaging feature. In asymptomatic patients without appendiceal inflammation, the appendix can be dilated by intraluminal material such as inspissated succus in cystic fibrosis or mucus from benign appendiceal mucocele. Finally, neoplasms such as typical appendiceal carcinoid tumor and mucinous adenocarcinoma can involve the appendix. Carcinoids are often small and incidentally discovered at pathologic examination, while malignant mucinous adenocarcinoma tends to present with advanced disease including pseudomyxoma peritonei. Cecal cancers can also obstruct the appendiceal lumen and cause acute appendicitis; an astute radiologist can recognize this prospectively and facilitate definitive resection (right hemicolectomy) at the time of surgery. Attention to mural features, cecal configuration, and periappendiceal inflammation is essential to the correct prospective diagnosis of complicated appendicitis and less common appendiceal pathologies. [ABSTRACT FROM AUTHOR]

The appendix may demonstrate a perplexing range of normal and abnormal appearances on imaging exams. Familiarity with the anatomy and anatomical variants of the appendix is helpful in identifying the appendix on ultrasound, computed tomography, and magnetic resonance imaging. Knowledge of the variety of pathologies afflicting the appendix and of the spectrum of imaging findings may be particularly useful to the emergency radiologist for accurate diagnosis and appropriate guidance regarding clinical and surgical management. In this pictorial essay, we review appendiceal embryology, anatomical variants such as Amyand hernias, and pathologies from appendicitis to carcinoid, mucinous, and nonmucinous epithelial neoplasms. [ABSTRACT FROM AUTHOR]

Aim The practice of routine or selective interval appendicectomy (IA) following successful conservative treatment of appendix mass is a matter of debate. Predictors of recurrence may be elucidated by correlating demographic and disease course data with high risk histology obtained at IA. Material and Methods Children having undergone IA between 2002 and 2012 were identified. Histology of specimens were reviewed by two clinicians and categorised as low or high risk of recurrence. Demographic and treatment course data was analysed using Fishers exact for nominal and Mann-Whitney U test for continuous data, to demonstrate association with histological risk. Results Thirty-nine children were identified, median age 11 years (range 3-15) and weight 37kg (9 -77Kg). We report recurrence of symptoms in 33%. Seventy-two percent had histologically high risk of recurrence. Demographic data was comparable between the two groups. Predictors of high risk included: palpation of a clear abdominal mass on initial exam (PPV 83%), ultrasound findings of a clearly visualised appendix phlegmon (OR 5.25, p=0.038) or faecolith (OR 2.25, p=0.35), recurrence of symptoms and readmission (OR 2.4, 2.3 p=0.3, p=0.29). Conclusion Only ultrasound appearance of clearly defined appendix phlegmon reached statistical significance to predict outcome. This information can be used in counselling families following successful conservative treatment of an appendix mass. [ABSTRACT FROM AUTHOR]