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Purpose: TULAA combines the laparoscopic and open technique and is considered to be a safe, fast and cost-effective procedure. On the other hand, preparation is limited due to the single instrument, especially in complicated appendicitis. In this study we analyze the outcome of our TULAA patients, focusing on conversion and complication rates. Methods: We performed a retrospective study including all patients treated with TULAA in our department between 2006 and 2016. We analyzed patient data, operative data, costs, complications, and conversion rate to standard laparoscopic or open appendectomy. Results: 1275 children and adolescents were enrolled. Mean age was 10.2 years. TULAA was completed in 88% of cases. The overall mean operative time was 33 min. The overall complication rate was 5.7%. The most common complications were wound infection (2.7%), seroma (1.7%) and wound abscess (1.4%). Both the conversion rate and the complication rate were significantly higher in complicated appendicitis. Furthermore, the conversion rate is higher in overweight or obese patients. Conclusion: TULAA is a safe, quick and cost-effective treatment option for acute appendicitis in children and adolescents. The complication rate and conversion rate are significantly correlated with the degree of appendiceal inflammation and comparable other surgical procedures. [ABSTRACT FROM AUTHOR]

Background: This study aimed to assess the impact of peritoneal drainage and its type on prognosis, encompassing postoperative recovery and complications, in pediatric patients (≤ 16 years old) following appendectomy based on the grade of appendicitis. Methods: In this retrospective study, we analyzed pediatric patients (≤ 16 years old) with appendicitis who met the inclusion and exclusion criteria in our center from January 2017 to January 2024 and classified them into grade I–V based on the grade of appendicitis, with V representing the most serious cases. The patients were grouped according to drainage status and type. The main clinical outcomes included postoperative rehabilitation indexes such as time to resume a soft diet, time to remove the drain, duration of postoperative antibiotic use and length of hospitalization (LOH), as well as postoperative complications including intra-abdominal abscess (IAA), ileus and wound infection (WI), and readmission within 30 days after surgery. Results: A total of 385 pediatric patients with appendicitis were included in the study and divided into No-drainage (ND) group (n = 74), Passive drainage (PD) group (n = 246) and Active drainage (AD) group (n = 65) according to drainage status and type. Compared to the other two groups, the ND group had a significantly shorter time to resume a soft diet, duration of postoperative antibiotic use and LOH, and these differences were statistically significant. Similar findings were observed in grade I patients too (P < 0.05). In all cases examined here, the AD group had a significantly shorter time for drain removal compared to the PD group (3.04 [1–12] vs 2.74 [1–15], P = 0.049); this difference was also evident among grade I patients (2.80 [1–6] vs 2.47 [1–9], P = 0.019). Furthermore, within the same grade, only in grade IV did the AD group exhibit a shorter duration of postoperative antibiotic use compared to the PD group (4.75 [4–5] vs 8.33 [5–15], P = 0.009). Additionally, the LOH in the AD group was longer than that in the PD group (8.00 [4–13] vs 4.75 [4–5], P = 0.025). Among all cases, the ND group exhibited significantly lower incidences of overall complications and WI compared to the other two groups (P < 0.05). Additionally, the incidence of IAA in the ND group was significantly lower than that in the PD group (0% vs 5.3%, P = 0.008 < 0.0167). Furthermore, although there were no statistically significant differences in the incidence of overall complications, IAA, ileus, and WI between the PD and AD groups during grade ≥ II analysis (P > 0.05), a higher readmission rate within 30 days was observed in the PD group compared to the AD group; however, these differences were not statistically significant (P > 0.05). Moreover, multivariate analysis revealed that a higher grade of appendicitis was associated with an increased risk of overall complications and IAA as well as a longer duration of postoperative antibiotic use and LOH. Conclusion: The appendicitis grade is a crucial indicator for predicting postoperative IAA and LOH. In patients with grade I appendicitis, peritoneal drainage, even if active drainage, is not recommended; For patients with grade ≥ II appendicitis, active drainage may be more effective than passive drainage in reducing the duration of postoperative antibiotic use and LOH. [ABSTRACT FROM AUTHOR]

Background: The distinction between complicated and uncomplicated acute appendicitis (AA) is important as it guides postoperative antibiotic treatment. A diagnosis based on intraoperative findings is imprecise and standard cultivation of peritoneal fluid is generally time-consuming with little clinical benefit. The aim of this study was to examine if cultivation of peritoneal fluid in acute appendicitis could reliably detect bacteria within 24 h. Methods: Patients older than 18 years undergoing laparoscopic appendectomy were prospectively enrolled at two surgical departments after informed consent was obtained. Periappendicular fluid was collected prior to appendectomy and sent for cultivation. Sensitivity, specificity and positive and negative predictive values were calculated with 95% confidence intervals (CIs) using 72-hour cultivation results as the gold standard. Patients with complicated AA as determined by the surgeon, received a three-day course of oral antibiotics. Postoperative infectious complications within 30 days after surgery were registered. Results: From July 2020 to January 2021, 101 patients were included. The intraoperative diagnosis was complicated AA in 34 cases. Of these patients, six (17.6%) had bacteria cultured within 24 h after surgery, leading to a sensitivity of 60% and a specificity of 100%. The positive and negative predictive values were 1.00 and 0.96, respectively. Seven patients developed a postoperative infection (five superficial wound infections and two intra-abdominal abscess). In all cases with a positive cultivation result, the intraoperative diagnosis was complicated appendicitis and a postoperative course of antibiotics prescribed. Conclusion: Twenty-four-hour cultivation of the peritoneal fluid in acute appendicitis is a valid indicator for peritoneal bacterial contamination. Randomized studies are necessary to determine if this approach is suitable for targeting postoperative antibiotic treatment as a means to prevent overtreatment without increasing the risk of infectious complications. [ABSTRACT FROM AUTHOR]

Background: Laparoscopic appendicectomy is commonly performed in Australia for treatment of acute appendicitis. Intra-abdominal abscess (IAA) is a potential complication following appendicectomy for acute appendicitis. Risk factors for developing post-operative IAA remain controversial and poorly defined. Laparoscopic washout may be performed for patients who develop complication(s) including IAA. The aim of this study was to define risk factors for both the development of IAA and identify patients who may require laparoscopic washout following appendicectomy. Methods: Data were obtained from 423 patients who underwent laparoscopic appendicectomy over a five-year period (2012–2017). Clinical (fever, haemodynamics, examination findings), biochemical (white cell count, neutrophil count, C-reactive protein, bilirubin, albumin), radiological (CT free fluid), and operative factors (inflammation, suppuration, free-fluid, perforation, histopathology) collected in the pre-, peri-, and post-operative period(s) were analysed. Results: 23 (5.4%) patients developed post-operative IAA. Duration of intravenous antibiotics was significantly longer in patients who developed IAA and in those who required laparoscopic washout (p < 0.0001). C-reactive protein (CRP) on admission (p < 0.05) and appendiceal perforation (p = 0.0005) were significantly higher in patients who either developed IAA or needed laparoscopic washout. No clinical or radiological finding predicted either the development of IAA or need for laparoscopic washout. Conclusion: Elevated CRP on admission may predict the development of post-operative IAA formation or the need for laparoscopic washout post-appendicectomy. Prolonged post-operative antibiotic use appears independent of the development of IAA as well as the need for laparoscopic washout. These data highlight the need for clear guidelines on peri-operative antibiotic use following appendicectomy. [ABSTRACT FROM AUTHOR]

Background: Educational video datasets can be an effective method for training in emergency department (ED) point-of-care ultrasound (PoCUS). A video dataset for normal appendix and appendicitis in children using ED PoCUS images was developed to assess interobserver agreement, as measured by Cohen's Kappa on key sonographic findings. Methods: Three sets of 25 ED PoCUS videos were selected and curated from pediatric patients with normal appendix and acute appendicitis. Four participant ED sonologist-physicians were trained on the first set of 25 videos showing normal appendix or normal bowel in patients without appendicitis to note if normal appendix was seen in any part or in it's entirety from tip-to-cecum. They were then tested on the second set of similar videos. A third set of 25 videos from patients who had appendicitis where participant sonologists were asked to note if appendicitis was present or absent, with and without appendicolith or perforation. Cohen's Kappa was calculated in aggregate and stratified by experience vs. novice against a senior sonologist-physician aware of all patient outcomes for visualization of: 1. any part of normal appendix, 2. normal appendix visualized from tip to cecum 3. any part of appendicitis, 4. appendicolith, 5. appendiceal perforation. Results: Cohen's Kappa for any part of normal appendix, 0.71, 95% CI (0.58–0.85); normal appendix tip-to-cecum, 0.43, 95% CI (0.19–0.67), appendicitis, 0.53, 95%CI (0.34–0.70), appendicolith, 0.63, 95%CI (0.43–0.84), perforated appendicitis, 0.46, 95%CI (0.22–0.70). Stratified by experienced vs. novice: any part of normal appendix, 0.75 vs. 0.68; normal appendix tip-to-cecum, 0.50 vs. 0.36; appendicitis, 0.78 vs. 0.31; appendicolith, 0.75 vs. 0.5; perforated appendicitis, 0.5 vs 0.42. Conclusions: This educational video dataset may be used to train sonologist-physicians in ED PoCUS scanning for normal appendix and appendicitis in children. Sonologist experience affected interobserver agreement with respect to visualization of entire normal appendix and appendicitis. [ABSTRACT FROM AUTHOR]

Background: Appendiceal goblet cell adenocarcinoma (GCA) is a rare subtype of primary appendiceal adenocarcinoma with an incidence of 1–5 per 10,000,000 people per year. Appendiceal tumors are often diagnosed after appendectomy for acute appendicitis. Notably, however, there is currently no standard treatment strategy for GCA, including additional resection. We report a case of appendiceal GCA with perineural extension into the cecum, in which ileal resection was considered effective. Case presentation: A 41-year-old man was diagnosed with acute appendicitis and underwent appendectomy. Histopathological findings revealed GCA (T3, Pn1). He was referred to our hospital for additional resection. Preoperative examination indicated a diagnosis of GCA cT3N0M0. Laparoscopic ileocecal resection and D3 lymph node dissection were performed 2 months after initial appendectomy. The patient had a good postoperative course and was discharged 8 days after surgery. Histopathological findings showed a GCA invading the cecum, despite an intact appendiceal stump, no lymph node metastasis, no vascular invasion, and no horizontal extension into the submucosa. Direct invasion of the tumor through the serosa was not observed, but perineural extension was conspicuous in the cecum, suggesting that the GCA extended into the cecum via perineural invasion. The resection margins were negative. The patient has survived free of recurrence for a year after ileocecal resection. Conclusions: The current patient was diagnosed with appendiceal GCA following appendectomy for acute appendicitis. Despite intact of appendiceal stump and no evidence of lymph node or distant metastasis, he underwent laparoscopic ileocecal resection and D3 lymph node dissection 2 months after initial appendectomy, with a favorable outcome. Despite the detection of perineural invasion, the patient declined adjuvant therapy. This case suggests that extensive resection may be required in patients with appendiceal GCA, but the role of adjuvant therapy remains unclear. [ABSTRACT FROM AUTHOR]

Background: Acute appendicitis (AA) is one of the most prevalent acute abdominal diseases and appendectomy is the definitive treatment of appendicitis. However, whether appendicitis and appendectomy cause colorectal cancer (CRC) is controversial. The results of observational studies are contradictory, but randomized controlled trials (RCT) cannot be conducted. Methods: Data of appendectomy, AA, and CRC were obtained from the IEU Open GWAS project. We selected several Genome-wide association studies (GWAS) summary statistics for CRC: statistics for colon cancer (CC) were obtained from MRC-IEU and Neale lab, respectively; statistics for rectum cancer (RC) were obtained from MRC-IEU and FinnGen, respectively; statistics for CRC were provided by Sakaue S et al. Mendelian randomization (MR) was used to evaluate the causal relationships between exposure and outcomes. Inverse variance weighting (IVW) was the most important analysis method. Meta-analysis was used to summarize the results of IVW to increase the reliability and sensitivity analysis was used to evaluate the robustness of the results. Results: According to the results of IVW, appendectomy did not increase risk of CC: MRC-IEU (OR:1.009, 95%CI:0.984-1.035, P=0.494), Neale lab (OR:1.016, 95%CI:0.993-1.040, P=0.174); Appendectomy also did not increase risk of RC: MRC-IEU(OR:0.994, 95%CI:0.974-1.014, P=0.538), FinnGen(OR:2.791, 95% CI:0.013-580.763, P=0.706); Appendectomy also did not increase risk of CRC: Sakaue S(OR:1.382, 95%CI:0.301-6.352, P=0.678). Appendicitis did not increase risk of CC: MRC-IEU(OR:1.000, 95%CI:0.999-1.001, P=0.641), Neale lab (OR:1.000, 95%CI:1.000-1.001, P=0.319); Appendicitis also did not increase risk of RC: MRC-IEU(OR:1.000, 95%CI:0.999-1.000, P=0.361), FinnGen(OR:0.903, 95%CI:0.737-1.105, P=0.321); Appendicitis also did not increase risk of CRC: Sakaue S (OR:1.018, 95%CI:0.950-1.091, P=0.609). The results of Meta-analysis also showed appendectomy (P=0.459) and appendicitis (P=0.999) did not increase the risk of CRC. Conclusions: Appendectomy and appendicitis do not increase the risk of colorectal cancer. More clinical trials are needed in the future to verify the causal relationships. [ABSTRACT FROM AUTHOR]

Background Acute appendicitis is a common surgical emergency, and accurate imaging is crucial for diagnosis. This study aims to compare the diagnostic accuracy of ultrasound (US) and computed tomography (CT) imaging in adult patients presenting with symptoms suggestive of acute appendicitis. Methods A prospective study was conducted on 100 adult patients (50 males and 50 females) with a mean age of 35 years (range: 18-60 years). Each patient underwent both US and CT imaging. The diagnostic accuracy, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of both imaging modalities were calculated and compared. Results Ultrasound imaging demonstrated a sensitivity of 75% (95% CI: 64%-84%), specificity of 85% (95% CI: 75%-92%), PPV of 81% (95% CI: 70%-89%), and NPV of 80% (95% CI: 70%-88%). CT imaging showed a sensitivity of 94% (95% CI: 86%-98%), specificity of 90% (95% CI: 81%-96%), PPV of 92% (95% CI: 84%-97%), and NPV of 93% (95% CI: 85%-98%). The accuracy of US was 79%, while CT achieved 92%. Comparative analysis revealed that CT imaging had significantly higher sensitivity (p<0.05) than ultrasound, with no significant difference in specificity (p>0.05). Conclusion CT imaging demonstrates superior diagnostic accuracy and sensitivity compared to ultrasound in diagnosing acute appendicitis in adults, though both modalities have comparable specificity. CT should be preferred for its higher diagnostic confidence, especially in equivocal cases. [ABSTRACT FROM AUTHOR]

Background: Appendicectomy is a common surgical procedure for children presenting with appendicitis. Understanding the impact of appendicectomy on daily activities and social life is crucial for optimizing patient outcomes. Aims and Objectives: This study aimed to assess the impact of appendicectomy on children's daily activities and social lives. Materials and Methods: A retrospective analysis was conducted of patients aged ≥5 years who underwent appendicectomy at our center between April 2022 and April 2023. Data on demographics, surgical approach (open or laparoscopic), post-operative outcomes, and return to daily activities were collected using a standardized questionnaire. Results: Among the 70 identified cases, there was a male predominance (63%), with most presenting with acute appendicitis (85%). Laparoscopic appendectomy was the predominant surgical approach used (80%). Post-operative symptoms included pain (n=12), vomiting (n=3), fever (n=2), and wound infection (n=6). Appendicular abscesses were found in 9% of laparoscopic surgeries and 14% of open surgeries. The average duration of hospital stay was shorter in laparoscopic cases. Return to school and normal diet varied between surgical approaches, with laparoscopic cases generally showing a quicker recovery. Conclusion: Although appendicectomy is commonly performed, it has implications for children's daily routines and social interactions. Parental anxiety plays a crucial role in post-operative recovery. Future studies should focus on addressing these social determinants to optimize patient outcomes. [ABSTRACT FROM AUTHOR]

Chyloperitoneum is the presence of chyle in the peritoneal cavity. This study focuses on acute chyloperitoneum, a rare condition with an unclear incidence due to limited number of reported cases in the literature. Here, we present a 24-year-old Saudi female with chyloperitoneum diagnosed intraoperatively during a laparoscopic appendectomy for acute appendicitis that was managed successfully with a low-fat diet and drainage, alongside a literature review to elucidate the condition's pathophysiology and therapeutic strategies. A conservative management approach is recommended for acute chyloperitoneum in the context of appendicitis, this includes intraperitoneal drainage, appendectomy when needed, and careful observation. Our proposed management strategy aligns with findings from the literature review and supports conservative management as a safe and effective treatment modality for this rare condition. [ABSTRACT FROM AUTHOR]

Introduction: Diagnosing acute appendicitis in paediatric patients remains a challenge. Various diagnostic tools have been proposed to be used in predicting acute appendicitis including scoring, radiology, and laboratory tests. Objective: We plan to study Neutrophil to Lymphocyte Ratio (NLR) and Platelet to Lymphocyte Ratio (PLR) as laboratory markers in predicting acute appendicitis. Method: Paediatric patients diagnosed with appendicitis were studied retrospectively. Control group was taken from hypospadia and undescendent testis patients whose blood tests were taken before surgery. A total of 124 patients were included, consisting of 69 patients in appendicitis group and 55 patients in control group. Result: There is significant comparison in NLR (p=0.000) and PLR (p=0.000) between appendicitis and control group. Area Under the Curve for NLR as a diagnostic tool was found to be 0.954. Cut-off point was found at 2.83 with 85% sensitivity and 96% specificity. Area Under the Curve for PLR as a diagnostic tool was found to be 0.858. Cut-off point was found at 123.9 with 87% sensitivity and 73% specificity. Conclusion: We suggest that NLR and PLR are reliable laboratory tests in predicting appendicitis. Further studies in bigger populations are required. [ABSTRACT FROM AUTHOR]

Conservative treatment of acute appendicitis is gaining popularity, and identifying patients with a higher risk of recurrence is becoming increasingly important. Previous studies have suggested that older age, male sex, diabetes, appendicolith and abscess formation may be contributing factors, however, results from the adult population are inconsistent. This study aims to identify predictive factors for recurrent appendicitis after conservative treatment. This retrospective study included patients with conservatively treated acute appendicitis at Skåne University Hospital, Sweden during 2012-2019. Information on patient demographics at index admission and follow-up data were retrieved from medical charts and radiologic images. Uni -and multivariable logistic regression analysis were performed using Stata Statistical Software. In total, 379 patients with conservatively treated acute appendicitis were identified, of which 78 (20.6%) had recurrence. All patients were followed-up for a minimum of 41 months after the first diagnosis of acute appendicitis unless appendectomy after successful conservative treatment or death occurred during follow-up. The median time to recurrence was 6.5 (1–17.8) months. After multivariable logistic regression analysis, external appendix diameter >10 mm [OR 2.4 (CI 1.37–4.21), p =.002] and intra-abdominal abscess [OR 2.05 (CI 1.18–3.56), p =.011] on computed tomography were significant independent risk factors for recurrent appendicitis. Appendicolith was not associated with an increased risk of recurrence. This study suggests abscess formation and appendix distension of >10 mm to be potential risk factors for recurrent acute appendicitis after initial successful conservative treatment. [ABSTRACT FROM AUTHOR]

Pediatric surgical care is becoming increasingly regionalized, often resulting in limited access. Interfacility transfers pose a significant financial and emotional burden to when they are potentially avoidable. Of transferred patients, we sought to identify clinical factors associated with avoidable transfers in pediatric patients with suspected appendicitis. We performed a single-center retrospective study at an academic tertiary referral children's hospital in an urban setting. We included children who underwent interfacility transfer to our center with a transfer diagnosis of appendicitis from July 1, 2021 to June 30, 2023. Encounters were designated as either an appropriate transfer (underwent appendectomy) or an avoidable transfer (did not undergo appendectomy). Encounters treated nonoperatively for complicated appendicitis were excluded. Bivariate analysis was performed using Mann-Whitney test and chi-square tests. A total of 444 patients were included: 71.2% were classified as appropriate transfers and 28.8% as avoidable transfers. Patients with avoidable transfer were younger compared to those in the appropriate transfer cohort (median age 9 y, interquartile range: 7-13 versus 11 y, interquartile range: 8-14; P < 0.001). Avoidable transfers less frequently presented with the typical symptoms of fever, migratory abdominal pain, anorexia, and nausea/emesis (P = 0.005). Avoidable transfers also reported shorter symptom duration (P = 0.040) with lower median white blood cell count (P < 0.001), neutrophil percentage (P < 0.001), and C-reactive protein levels (P < 0.003). Avoidable transfers more frequently underwent repeat imaging upon arrival (42.9% versus 12.7%, P < 0.001). These findings highlight the importance of clinical history in children with suspected appendicitis. Younger patients without typical symptoms of appendicitis, those with a shorter duration of symptoms, and lower serum inflammatory markers may benefit from close observation without transfer. [ABSTRACT FROM AUTHOR]

Key Clinical Message: Perforation of Meckel's diverticulum (MD) is rare, particularly by foreign body. High index of suspicion and thorough intraoperative assessment is needed in patients undergoing surgery for acute appendicitis, specifically when appendix appears normal. Meckel's diverticulum is the most common congenital anomaly of the gastrointestinal tract. While often asymptomatic, it can present with several complications. Perforation due to foreign body ingestion is rare but can have severe consequences if late diagnosis occurs. A 13‐year‐old male, initially suspected of acute appendicitis, was eventually diagnosed with perforation of MD by a wood splinter‐like foreign body after intraoperative assessment. Histological analysis revealed ectopic colonic tissue within the MD, a finding whose implications are not well understood, in contrast with the well‐established complications associated with ectopic gastric and pancreatic tissues. This case highlights the diagnostic challenges of MD, which can mimic acute appendicitis, emphasizing the need for high suspicion when faced with atypical clinical presentation such as foreign body‐induced perforation. Although surgical resection of asymptomatic MD remains controversial, we recommend a case‐specific approach based on risk factors to guide decision‐making on surgical resection for asymptomatic MD. [ABSTRACT FROM AUTHOR]

Complicated appendicitis is associated with a higher risk of postoperative complications, including adhesive bowel obstruction. The aim of this meta-analysis is to investigate the difference in rates of postoperative bowel obstruction in paediatric patients with complicated versus simple appendicitis and whether this is influenced by the surgical approach. A systematic literature search following PRISMA guidelines was conducted using MEDLINE, Embase and Cochrane Library for studies that analysed incidence of adhesive bowel obstruction in paediatric patients after appendicectomy. Studies from 1998 to 2022 were included in analysis. The study protocol was registered on PROSPERO (ID CRD42022309769). Pooled analysis of 6 studies with low risk of bias and adequate follow up periods, considering 58,962 cases of appendicectomy, revealed complex appendicitis was associated with a near two-fold increase in incidence of SBO (pooled odds ratio 2.02 (95% CI 1.35–2.69)). Interestingly, a similar pooled analysis of 10 studies, considering 62,433 cases of appendicectomy, revealed no significant difference between open and laparoscopic management of complex appendicitis (pooled odds ratio 0.93 (95% CI 0.24 to 1.62)). Complex appendicitis is associated with a two-fold increase in the rates of adhesive bowel obstruction. Whilst there are cosmetic advantages of a laparoscopic approach, surgical expertise should be favoured in decision making relating to surgical approach (laparoscopic versus open) as the evidence for a laparoscopic approach reducing risks of adhesive bowel obstruction is not convincing. Level II. • What is currently known about this topic? Complex appendicitis is associated with increased risk of adhesive bowel obstruction and LA is preferred to OA to reduce rates of adhesive bowel obstruction. • What new information is contained in this article? Combined synthesis of more recent literature and evaluation for study bias reveals surgical approach does not appear to increase risk of adhesive bowel obstruction. [ABSTRACT FROM AUTHOR]

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Abstract Background The present study investigated the level of 5-hydroxyindoleacetic acid (5-HIAA) in perforated and nonperforated appendicitis patients. This issue is important for timely diagnosis of acute appendicitis complications and making decision about the surgical plan and type of incision. Methods This prospective study was conducted on patients with acute appendicitis. 5-HIAA levels were measured in urine spot sample of every patient before the surgery. The patients were finally included based on result of pathology for presence of appendicitis or not and sorted by direct surgical detection for exist of perforation or not. The sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy of 5-HIAA were investigated. The data were statistically analyzed by SPSS v.27. Results A total of 150 patients were included in two groups as 40 patients in the perforated appendicitis group and 110 patients in the noncomplicated acute appendicitis group. The average age of patients in the perforated appendicitis group was 28.8 ± 6.07 years, and that of patients in the acute appendicitis group was 29.6 ± 6.96 years. 94 patients (63%) were male, and 56 (37%) were female. No significant difference was observed in terms of age or sex between the two groups. The difference in the 5-HIAA concentration between the acute appendicitis group (0.3 ± 0.04 mg/dl) and the perforated appendicitis group (0.5 ± 0.03 mg/dl) was significant (P

Abstract Purpose Surgical site infection (SSI) is common after laparoscopic appendectomy, resulting in prolonged hospital stay and increased costs. This study examined the relationship between body composition parameters and risk of incisional SSI in patients with complicated appendicitis. Methods We included 411 patients who underwent laparoscopic surgery for complicated appendicitis at a single institution between March 2015 and October 2023. Body composition parameters were derived from preoperative computed tomography (CT). A nomogram was constructed based on the independent predictors of incisional SSI. Results Overall, 45 (10.9%) patients developed incisional SSI. Visceral fat area (VFA) was independently associated with risk of incisional SSI (hazard ratio 1.015, 95% confidence interval 1.010–1.020, P

Abstract The relationship between simple appendicitis and inflammatory bowel disease (IBD) is not clear. In this study, we approach the issue from a genetic perspective, using Mendelian randomization (MR) tools to explore the potential causal connection between the two. We used GWAS data from 12,882 IBD patients (21,770 controls), 5956 crohn’s disease (CD) patients (14,927 controls), 6968 ulcerative colitis (UC) patients (20,464 controls), and 4604 simple appendicitis patients (481,880 controls). These statistical data were derived from a large-scale whole-genome association study of individuals with European ancestry. The primary analytical method for inferring the causal relationship between the conditions involved the use of the Inverse Variance Weighting (IVW) method as the main approach for bidirectional MR analysis. The MR analysis results predicted IBD was associated with a lower risk of simple appendicitis (OR: 0.947 (0.911, 0.984), p = 0.005). The results for CD (OR: 0.948 (0.916, 0.981), p = 0.002) and UC (OR: 0.954 (0.917, 0.992), p = 0.020) are consistent with this finding. In the reverse MR analysis, there is no significant association between simple appendicitis and the occurrence of IBD (p > 0.05), and the same holds true for CD and UC (p > 0.05). Our MR study results suggest a potential negative causal effect of IBD on the occurrence of simple appendicitis. Conversely, there does not appear to be a significant causal relationship between simple appendicitis and the risk of developing IBD.

Intestinal nonrotation is the most common type of mid-gut anomaly where the small bowel predominantly occupies the right side of the peritoneal cavity, while the colon primarily resides on the left. The occurrence of acute appendicitis in mid-gut anomalies poses a serious diagnostic challenge due to unprecedented clinical and imaging features. Here we present a 20-year-old female who came to the hospital with left lower abdominal pain of 3 weeks duration, referred with a diagnosis of tubo-ovarian abscess. Further evaluation with an abdominopelvic CT scan revealed ileocecal junction in the left lower quadrant with a well-defined appendiceal abscess. The absence of a prior diagnosis of nonrotation, combined with the atypical presentation of pain, complicates the diagnosis of appendicitis. We emphasize the significance of considering left-sided appendicitis as a potential diagnosis for left-sided abdominal pain and recommend early cross-sectional imaging to prevent complications and improve surgical outcomes.

Introduction: Acute appendicitis is a common surgical emergency in children, often requiring imaging for confirmation due to diverse presentations. While computed tomography scan is favored in many centers for its sensitivity, it comes with radiation exposure and higher costs. Ultrasonography, being radiation-free and cost-effective, is gaining popularity, especially in pediatric cases. However, its reported accuracy varies in the literature. This study aims to evaluate the diagnostic accuracy of ultrasonography in pediatric appendicitis cases and to determine its precision in distinguishing between simple and complicated cases of appendicitis. MATERIALS AND METHODS: A retrospective analysis was conducted on children with suspected appendicitis who presented to the department of pediatric surgery. All patients underwent ultrasonography followed by appendicectomy based on considered clinical decision. Ultrasonography findings were compared with intraoperative observations categorized as uncomplicated or complicated appendicitis. Results: Among 152 patients, ultrasonography accurately diagnosed appendicitis in 94.6% of cases, with 5.38% having nonvisualized appendices. In our group, the sensitivity and specificity of ultrasound to detect appendicitis were 94.62% and 95.65%, respectively. The diagnostic accuracy of the test is 95.63%. However, in our study, the sensitivity of the ultrasonography to correctly identify if it is a simple or complicated appendicitis was only 54.9% but had a specificity of 98.7%. Thus, ultrasonography showed a much lower sensitivity (54.9%) in distinguishing between simple and complicated appendicitis. Conclusion: Ultrasonography demonstrates high sensitivity and specificity in diagnosing pediatric appendicitis, making it a promising preoperative investigation. However, it may not accurately differentiate between simple and complicated cases. A comprehensive approach involving clinical and laboratory parameters alongside secondary imaging may be necessary for accurate diagnosis, especially in cases of perforated appendicitis.

Abstract Background The diagnosis and management of fever of unknown origin pose significant challenges in the field of infectious diseases, as it is influenced by various factors. Infectious diseases have long been recognized as the primary etiology of fever of unknown origin. However, not all infectious diseases can definitively identify the causative pathogen and infection sites. Case presentation we present a case report of an individual with fever, nausea, and anorexia but did not report any abdominal pain. Physical examination revealed no signs of abdominal tenderness. Repeated imaging studies including enhanced CT and color US of the appendix, only one color US suggested the possibility of appendicitis. Despite effective anti-infective treatment, the patient continued to experience low-grade fever, leading to the decision for laparoscopic exploration and subsequent appendectomy. Pathological findings confirmed the presence of appendicitis. After the surgical procedure, the patient’s temperature and infectious markers returned to within normal range, ultimately leading to a diagnosis of appendicitis. Conclusions The atypical symptoms and signs, along with the negative imaging results, contribute to the under diagnosis of appendicitis and the progression of fever of unknown origin, thereby exacerbating the physical, mental, and economic burden on patients. Consequently, there are valuable insights to be gained regarding the management of both appendicitis and fever of unknown origin.

Abstract Background Pinworm, Enterobius vermicularis, is a common parasitic illness, particularly among children in Palestine. On rare occasions, it can cause serious consequences such as acute appendicitis, which can still present a challenging diagnosis especially in children. Case presentation This report describes two cases (a 9 year old male and a 11 year old female, both Palestinian children from Hebron district) of acute appendicitis referred to Queen Alia Hebron Governmental Hospital in Palestine. The clinical examination revealed a lower abdominal pain, and they were diagnosed with appendicitis. The pathological examination after appendectomy showed the presence of eggs and pinworms. Anthelminthic medication was provided, and they were followed up for 6 weeks after the operation without any incidents. Conclusion These cases highlight the importance of considering Enterobius vermicularis infestation in children with abdominal pain, as the parasites can mimic appendicitis. Prompt recognition and cautious laparoscopic appendectomy are crucial to prevent unnecessary surgery and peritoneal contamination, with the infestation being easily treatable with anthelmintic medication.

Abstract Background The development of the human vermiform appendix at the cellular level, as well as its function, is not well understood. Appendicitis in preschool children, although uncommon, is associated with a high perforation rate and increased morbidity. Methods We performed single-cell RNA sequencing (scRNA-seq) on the human appendix during fetal and pediatric stages as well as preschool-age inflammatory appendices. Transcriptional features of each cell compartment were discussed in the developing appendix. Cellular interactions and differentiation trajectories were also investigated. We compared scRNA-seq profiles from preschool appendicitis to those of matched healthy controls to reveal disease-associated changes. Bulk transcriptomic data, immunohistochemistry, and real-time quantitative PCR were used to validate the findings. Results Our analysis identified 76 cell types in total and described the cellular atlas of the developing appendix. We discovered the potential role of the BMP signaling pathway in appendiceal epithelium development and identified HOXC8 and PITX2 as the specific regulons of appendix goblet cells. Higher pericyte coverage, endothelial angiogenesis, and goblet mucus scores together with lower epithelial and endothelial tight junction scores were found in the preschool appendix, which possibly contribute to the clinical features of preschool appendicitis. Preschool appendicitis scRNA-seq profiles revealed that the interleukin-17 signaling pathway may participate in the inflammation process. Conclusions Our study provides new insights into the development of the appendix and deepens the understanding of appendicitis in preschool children. Graphical Abstract

This case report presents the findings of colon adenocarcinoma in a young adult male who presented with vague abdominal pain as his only complaint, suspicious of appendicitis. The patient underwent abdominal computed tomography (CT) imaging for further evaluation of his abdominal pain. CT findings showed pericecal fat stranding and prominent lymph nodes concerning for acute appendicitis, but the appendix could not be adequately visualized; due to the indeterminate CT findings, general surgery proceeded to perform an exploratory laparotomy on the patient and removed an appendiceal mass-like structure that was revealed to be invasive adenocarcinoma of the colon per pathology. This case report details the radiological and pathological findings of colorectal adenocarcinoma presenting similarly to acute appendicitis and demonstrates that colorectal adenocarcinoma must be considered on the list of differentials in young adults presenting with abdominal pain and unclear CT imaging.

Epiploic appendagitis is a benign and self-limiting condition that has garnered more recognition, particularly in preoperative settings, thanks to advancements in imaging techniques, notably computed tomography (CT). Its distinct radiologic features facilitate accurate diagnosis prior to surgery. Despite its unique characteristics, the clinical presentation of epiploic appendagitis often resembles that of various other intra-abdominal medical and surgical conditions, leading to potential confusion. Here, we present the case of a 37-year-old otherwise healthy woman who was diagnosed with primary epiploic appendagitis based on CT scan findings conducted initially for suspected appendicitis. The patient received successful conservative treatment. This paper seeks to highlight the importance of recognizing this clinical condition and its characteristic imaging features, aiming to prevent unnecessary hospitalizations, antibiotic treatments, and the associated morbidity and mortality linked with surgical interventions.

Amyand's hernia is a rare type of inguinal hernia characterized by the presence of the vermiform appendix within the hernia sac. It was named after Claudius Amyand who performed the world's first successful appendectomy on an 11-year-old boy with a right inguinal hernia in 1735 and discovered a herniated appendix during surgery.This condition warrants urgent surgical treatment, with the type of surgical intervention depending on the appendix's condition. However, the nonspecific clinical presentation often complicates the preoperative diagnosis, emphasizing the critical role of imaging in surgical planning.Herein, we present the case of a 74-year-old male who presented with fever, inguinal swelling, and discomfort. Clinical suspicion of inguinal and scrotal inflammation prompted us to perform a prompt CT scan. This radiological evaluation led to a preoperative diagnosis of a Type 3 Amyand's hernia.This case highlights the significance of CT scans in the accurate and timely diagnosis of Amyand's hernia. Distinguishing between various types of Amyand's hernia is pivotal as it profoundly influences surgical decision-making and postoperative outcomes. By sharing this case, we contribute to current knowledge about Amyand's hernia, increase clinical awareness of the condition, and emphasize the crucial role of imaging in its management.

Background: Recent randomized trials have suggested non-operative management to be a safe alternative to appendectomy for acute uncomplicated appendicitis. Yet, there remains significant variability in treatment approach. This study sought to characterize center-level variation in non-operative management within a national cohort of adults presenting with appendicitis. Methods: The 2016–2020 Nationwide Readmissions Database was queried to identify all adult (≥18 years) hospitalizations for acute uncomplicated appendicitis. Hierarchical, mixed-effects models were developed to ascertain factors linked with non-operative management. Bayesian methodology was applied to predict random effects, which were then used to rank centers by increasing hospital-attributed rate of non-operative management. Institutions with high center-specific rates of non-operative management (>90th percentile) were considered low-operating hospitals (LOH). Results: Of an estimated 447,500 patients, 52,523 (11.7 %) were managed non-operatively. Compared to those undergoing appendectomy, the non-operative cohort was older, more commonly male, and of a higher comorbidity burden. Approximately 30 % in the variability of non-operative management was attributable to hospital effects, with absolute, risk-adjusted rates ranging from 0.5 to 22.5 %. Centers with non-operative management rates ≥90th percentile were considered LOH.Following risk adjustment, among patients undergoing appendectomy, care at LOH was linked with greater odds of postoperative infection, resource utilization, and non-elective readmission. Conclusions: We identified significant interhospital variation in the utilization of non-operative management for acute uncomplicated appendicitis. Further, we found LOH to be associated with inferior outcomes following surgical management. Future work is needed to assess the care pathways that contribute to increased utilization of non-operative strategies, and disseminate best practices across institutions.

BACKGROUND: As more patients with appendicitis are treated with antibiotics, factors associated with recurrence may help inform individualized prognostication and decision-making. METHODS: This cohort study, using data from the Comparison of Outcomes of Antibiotic Drugs and Appendectomy trial, examined patients treated with antibiotics who did not undergo appendicectomy in the first 30 days. Patients who had appendicectomy between 30 days and 1 year were compared with those who did not. Marginalized logistic regression models were used to calculate adjusted risk differences (RDs) to estimate the association between baseline patient factors and the risk of undergoing an appendicectomy between 30 days and 1 year. RESULTS: Of 601 patients treated with antibiotics who did not undergo appendicectomy within 30 days (mean age 38.0 years; 217 women (36.1 per cent)), 144 had an appendicectomy and 56 were lost to follow-up between 30 days and 1 year. The estimated rate of appendicectomy between 30 days and 1 year was 28.6 (95 per cent c.i. 25.0 to 32.8) per cent. After adjustment for other factors, nausea, vomiting, or anorexia at baseline presentation was associated with an increased rate of appendicectomy between 30 days and 1 year (adjusted RD 17.52, 95 per cent c.i. 8.64 to 26.40). The presence of an appendicolith (adjusted RD 3.64, -6.08 to 13.36), or an abscess, perforation, or fat stranding on initial imaging (adjusted RD -7.23, -17.41 to 2.95) was not strongly associated with appendicectomy between 30 days and 1 year. CONCLUSION: Most factors commonly associated with appendicitis severity were not strongly associated with an increased risk of undergoing appendicectomy in the longer term after treatment with antibiotics.

INTRODUCTION: Patients with acute uncomplicated appendicitis will be increasingly asked to choose between surgery and antibiotic management. We developed a novel decision aid for patients in the emergency department (ED) with acute appendicitis who are facing this choice. We describe the development of the decision aid and an initial feasibility study of its implementation in a busy tertiary care ED. MATERIALS AND METHODS: We conducted a prepost survey analysis comparing patients before and after standardized implementation of the decision aid. Patients were surveyed about their experience making treatment decisions after discharge from the hospital. The primary outcome measure was the total score on the decisional conflict scale (; 0-100; lower scores better). RESULTS: The study included 24 participants (12 in the predecision aid period; 12 in the post period). Only 33% of participants in each group knew antibiotics were a treatment option prior to arriving at the ED. Prior to implementing the use of decision aid, only 75% of patients reported being told antibiotics were a treatment option, while this increased to 100% after implementation of the decision aid. The mean total decisional conflict scalescores were similar in the pre and post periods (mean difference = 0.13, 95% CI: -13 - 13, P > 0.9). CONCLUSIONS: This novel appendicitis decision aid was effectively integrated into clinical practice and helped toinform patients about multiple treatment options. These data support further large-scale testing of the decision aid as part of standardized pathways for the management of patients with acute appendicitis.

In the myriad of clinical presentations of acute appendicitis, appendicular gastralgia remains a poorly researched entity. In this article, authors present a series of three cases of acute appendicitis that initially presented as appendicular gastralgia. A 35-year-old gentleman initially presented with complaints of epigastric pain of six hours’ duration with an Alvarado score of 3/10 and was managed medically. Re-examination after six hours of unresolved pain revealed Right Iliac Fossa (RIF) tenderness. Similarly, a 13-year-old boy presented with epigastric pain of 12 hours’ duration with a normal clinical examination and an Alvarado score of 5/10. The pain radiated to RIF after 12 hours with RIF tenderness. A 58-year-old lady presented with pain in the epigastrium of six hours’ duration and had a normal clinical examination, haematological and radiological parameters. She was initially managed medically. However, due to the non resolution of symptoms despite treatment, she underwent Contrast Enhanced Computed Tomography (CECT) Abdomen, which revealed a localised appendicular perforation with appendicoliths. All three patients underwent emergency laparoscopic appendectomy and had an uneventful postoperative recovery with no recurrence of epigastric pain. Low Alvarado scores, non specific clinical findings and equivocal imaging delay diagnosis in these cases. Through this article, attempt was made to enhance awareness of this entity amongst clinicians.

This study investigated all-cause and suicide mortality rates in adolescents and young adults following an initial psychiatric admission to elucidate the long-term outcomes for this vulnerable group by focusing on the risks associated with various psychiatric diagnostic categories. This study involved 9762 adolescents and young adults discharged from their first psychiatric admission and matched 1:1 with 9762 individuals discharged following a diagnosis of appendicitis on the basis of birth year and sex by using Taiwan's National Health Insurance Research Database. Both stratified (model 1) and standard (model 2) Cox regression analyses were conducted to assess variations in all-cause and suicide mortality between the groups. Over the 15-year follow-up period, the adolescents and young adults discharged from their first psychiatric admission exhibited an approximately 3-fold increased risk of death from any cause (hazard ratio [HR]: 2.97 in model 1, 2.83 in model 2) and an approximately ten times higher risk of suicide (11.13 in model 1, 9.23 in model 2) compared with those discharged with a diagnosis of appendicitis. Those discharged with alcohol use disorder or major depressive disorder exhibited higher hazard ratios for both all-cause and suicide compared with the reference group. The findings reveal a considerable risk of all-cause and suicide mortality in adolescents and young adults following discharge from their first psychiatric admission. These results highlight an urgent need for tailored interventions and continued support for this demographic. • Psychiatric admission for severe mental disorders in youth was related to all-cause mortality and suicide risk. • The increased mortality risk following the first psychiatric admission in the youth period persisted up to 15 years. • Alcohol use disorder, major depression, and bipolar disorder in youth were particularly associated with suicide death. [ABSTRACT FROM AUTHOR]

Neutropenia increases the complexity of surgical decision-making in cases of acute appendicitis. In this systematic review, we discuss medical vs surgical management and timing of appendectomy in the neutropenic adult patient. We queried databases utilizing the key words "neutropenia" and "appendicitis." The search identified 999 articles of which 481 articles were reviewed after duplicates were removed. Studies with pediatric patients, single case studies, and abdominal pain in neutropenic patients not caused by appendicitis were excluded. Seven studies remained in this review accounting for 130 patients, of which 28 were diagnosed with neutropenic appendicitis, and were included for final analysis. Four of the 7 articles were case reports, demonstrating the relative paucity of literature on this subject. Studies referred to the high risk of morbidity and mortality after surgical intervention in the neutropenic population, and attempting medical management first was common but not universal, reserving appendectomy for failure of medical management. Three studies suggested medical therapy as first-line management while 2 studies suggested surgical management and 2 studies did not distinguish a precedence. Both medical and surgical management have been successfully used in treating appendicitis in neutropenic patients. In most patients, medical management was attempted first (n = 16/28) vs immediate appendectomy (n = 7/28). Appendectomy was performed when medical management failed (n = 2/28) or after correction of neutropenia (n = 1/28). Timing or performance of appendectomy was unclear in 2 patients. With the increasing use of immunosuppressive medications, broad-spectrum antibiotics, and recent data from the CODA (Comparison of Outcomes of Antibiotic Drugs and Appendectomy) trial, medical management as a first-line treatment for most patients with neutropenia and appendicitis is warranted, and identifying a protocol for such patients would be of value. [ABSTRACT FROM AUTHOR]

Purpose: Emergency surgery (ES) for complicated appendicitis (CA) is associated with high morbidity. Interval appendectomy (IA) decreases this rate; however, nonoperative management (NOM) is not always successful. Some patients require unplanned ES due to NOM failure (IA failure: IA-F). This study aimed to verify the benefits of IA and to evaluate the risk factors for NOM failure. Methods: Patients diagnosed with CA who underwent surgery between January 2012 and December 2021 were included in this study. We compared the surgical outcomes of the ES group with those of the IA success (IA-S) and IA-F groups. We also analyzed 14 factors that predicted NOM failure. Results: Among 302 patients, the rate of severe complications (Clavien–Dindo grade ≥ III) was significantly higher in the ES group (N = 165) than in the IA-S group (N = 102). The rates were equal between the ES (N = 165) and IA-F (N = 35) groups. NOM was successful in 110 patients and failed in 27. Lack of abscesses, comorbidities, high WBC count, and free air were independent risk factors for NOM failure. Conclusions: Considering the benefits of IA and the non-inferior surgical outcomes of IA-F compared to ES, IA is a good therapeutic strategy for CA. However, in patients exhibiting four independent risk factors for NOM failure, careful monitoring of unplanned ES is necessary. [ABSTRACT FROM AUTHOR]

Background and Objective: Cases of appendicitis were identified in the pivotal randomized clinical trial on BNT162b2 mRNA vaccine and reported from coronavirus disease 2019 (COVID-19) vaccine pharmacovigilance systems. Three cohort studies and two self-controlled case series (SCCS) studies evaluating the association between mRNA vaccines and appendicitis reported discordant results. To address this uncertainty, the present study examines in a large population, with a SCCS design, the association between mRNA (BNT162b2 and mRNA-1273) and, for the first time, viral vector (ChAdOx1-S and Ad26.COV2-S) COVID-19 vaccines and acute appendicitis. Methods: The SCCS study design was used to evaluate the association between COVID-19 vaccination and subsequent onset of acute appendicitis. The study was based on record linkage of health archives through TheShinISS application, a statistical tool that locally processes data from regional health care databases according to ad hoc, study-tailored and common data model. The study population included all vaccinated subjects ≥ 12 years old between 27 December 2020 and 30 September 2021. The acute appendicitis was identified through discharge diagnoses of hospital admissions or emergency department visits. Incident cases were defined as those who experienced a first event of acute appendicitis in the study period, excluding subjects with a diagnosis of appendicitis in the previous 5 years. Exposure was defined as the first or second dose of BNT162b2, mRNA-1273 and ChAdOx1-S and the single dose of Ad26.COV2-S. The risk interval was defined as 42 days from the first or second vaccination dose and divided into pre-specified risk subperiods; the reference period was the observation time outside the risk interval. Relative incidences (RI) and 95% confidence intervals (95% CI) were estimated with the SCCS method 'modified for event-dependent exposures', through unbiased estimating equations. The seasonal component was considered as a time-dependent covariate. Results: In the 42-day risk interval 1285 incident cases of acute appendicitis occurred: 727 cases after the first dose and 558 cases after the second dose. In the main analysis, no increased risks of acute appendicitis were observed in subjects vaccinated with BNT162b, mRNA-1273, ChAdOx1-S and Ad26.COV2-S. The subgroup analyses by sex showed an increased risk in the 14–27 day risk interval, in males after the first dose of mRNA-1273 (RI of 1.71; 95% CI 1.08–2.70, p = 0.02) and in females after the single dose of Ad26.COV2-S (RI of 4.40; 95% CI 1.29–15.01, p = 0.02). Conclusions: There was no evidence of association of BNT162b, ChAdOx1-S, mRNA-1273 and Ad26.COV2-S with acute appendicitis in the general population. The results of the subgroup analyses by sex needs to be considered with caution. The multiplicity issue cannot be excluded being these hypotheses two of several hypotheses tested. In addition, relevant literature on the biological mechanism of the disease and evidence of similar effects with other vaccines or with the same vaccines are still lacking to provide strong support for a conclusion that there is an harmful effect in males and females with mRNA-1273 and Ad26.COV2-S. [ABSTRACT FROM AUTHOR]

The article presents a case study of a 17-year-old male who developed perforated appendicitis during the re-nourishment phase of treatment for an eating disorder. Topics discussed include the patient's significant weight loss and dietary practices, the medical team's management of his bradycardia and nutritional rehabilitation, and the complications that arose during hospitalization, ultimately leading to emergency surgery.

Artificial intelligence (AI) is a rapidly growing field with significant implications for radiology. Acute abdominal pain is a common clinical presentation that can range from benign conditions to life-threatening emergencies. The critical nature of these situations renders emergent abdominal imaging an ideal candidate for AI applications. CT, radiographs, and ultrasound are the most common modalities for imaging evaluation of these patients. For each modality, numerous studies have assessed the performance of AI models for detecting common pathologies, such as appendicitis, bowel obstruction, and cholecystitis. The capabilities of these models range from simple classification to detailed severity assessment. This narrative review explores the evolution, trends, and challenges in AI applications for evaluating acute abdominal pathologies. We review implementations of AI for non-traumatic and traumatic abdominal pathologies, with discussion of potential clinical impact, challenges, and future directions for the technology. [ABSTRACT FROM AUTHOR]

Purpose: The variable positions of the appendix can mislead surgeons and physicians to a wrong diagnosis. When appendicitis happens in subhepatic caecum, it can be misdiagnosed and can lead to severe complications during surgical procedures. Therefore, this study aimed to understand the histomorphometric development of the appendix and caecum and to identify when lymphoid follicles appear in the appendix during fetal life. Methods: The study was conducted on a total of 50 fetuses. The caecum and appendix were carefully dissected. Their position and various measurements were observed. Afterwards, the appendix was taken out for histological processing. All three layers, mucosa, submucosa, and muscularis externa were measured using Image Analyzer Software Image Pro Premiere 9.1, and the appearance of lymphoid follicles was also examined. Results were analyzed using SPSS statistical software. Results: During the 1st, 2nd, and 3rd trimesters the most common caecum type was type 1: as a lengthy tube, type 3: The lateral wall expanded more, thus it has an asymmetric saccule, and type 4: adult-like caecum. The caecum was mostly situated in the right lumbar region in the 2nd and 3rd trimesters. In the 1st trimester, it was subhepatic in position. The most common position of the appendix was 11 o'clock in 1st and 3rd trimesters. 2nd trimester's most common position of the appendix was 12 o'clock. The thickness of the mucosa, submucosa, and the muscularis externa increases as the trimester increases. The lymphoid follicles have appeared during the 2nd trimester. Conclusion: The knowledge from this study will be useful in the diagnosis and treatment of malformations, pathology, and anomalies of the caecum and appendix due to congenital causes. [ABSTRACT FROM AUTHOR]