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Background and aims Long pre-hospital delay substantially increases the likelihood of perforated appendicitis. This study aimed to find patient-related factors affecting this delay.Methods A survey was conducted for patients with acute appendicitis after appendectomy. The participants were asked about their path to the surgical center and socioeconomic status. Variables affecting delays and the rate of complicated appendicitis were analyzed.Results The study included 510 patients; 157 (31%) had complicated appendicitis with a median prehospital delay of 42 h. In patients with uncomplicated appendicitis, the delay was 21 h, p

Abstract Backgrounds Acute Appendicitis (AA) is one of the most common surgical emergencies worldwide. This study aims to investigate the predictive performances of 6 different Machine Learning (ML) algorithms for simple and complicated AA. Methods Data regarding operated AA patients between 2012 and 2022 were analyzed retrospectively. Based on operative findings, patients were evaluated under two groups: perforated AA and none-perforated AA. The features that showed statistical significance (p

Abstract Introduction Appendicectomy remains the standard treatment for appendicitis. There is a lack of clarity on the timeframe in which surgery should be performed to avoid unfavourable outcomes. Aim To perform a systematic review and network meta-analysis to evaluate the impact the (1)time-of-day surgery is performed (2), time elapsed from symptom onset to hospital presentation (patient time) (3), time elapsed from hospital presentation to surgery (hospital time), and (4)time elapsed from symptom onset to surgery (total time) have on appendicectomy outcomes. Methods A systematic review was performed as per PRISMA-NMA guidelines. The time-of-day which surgery was done was divided into day, evening and night. The other groups were divided into 48 h. The rate of complicated appendicitis, operative time, perforation, post-operative complications, surgical site infection (SSI), length of stay (LOS), readmission and mortality rates were analysed. Results Sixteen studies were included with a total of 232,678 patients. The time of day at which surgery was performed had no impact on outcomes. The incidence of complicated appendicitis, post-operative complications and LOS were significantly better when the hospital time and total time were 48 h after admission. The time-of-day which surgery is performed does not impact outcomes.

Abstract Background The emergence of the COVID-19 pandemic in December 2019 initiated a global transformation in healthcare practices, particularly with respect to hospital management. PCR testing mandates for medical treatment seekers were introduced to mitigate virus transmission. Aims This study examines the impact of these changes on the management of patients with appendicitis. Methods We conducted a retrospective analysis of medical records for 748 patients diagnosed with appendicitis who underwent surgery at a tertiary care hospital during two distinct periods, the pre-pandemic year 2019 and the post-pandemic year 2021. Patient demographics, clinical characteristics, laboratory data, surgical outcomes, and hospital stay duration were assessed. Results While no significant differences were observed in the general characteristics of patients between the two groups, the time from hospital visit to operation increased significantly during the pandemic. Unexpectedly, delayed surgical intervention was associated with shorter hospital stays but did not directly impact complication rates. There was no discernible variation in the type of surgery or surgical timing based on symptom onset. The pandemic also prompted an increase in appendicitis cases, potentially related to coronavirus protein expression within the appendix. Conclusions The COVID-19 pandemic has reshaped the landscape of appendicitis management. This study underscores the complex interplay of factors, including changes in hospital protocols, patient concerns, and surgical timing. Further research is needed to explore the potential link between COVID-19 and appendicitis. These insights are valuable for informing healthcare practices during and beyond the pandemic.

Background: The ectopic presence of helminths and their eggs in the appendix tube can directly and indirectly lead to the hyperplasia of lymphatic follicles in the walls of the tube by antigenic stimulation and thereby cause obstruction and subsequently acute appendicitis. The present study was designed to determine the extent of this role as well as the frequency of appendectomy samples with E. vermicularis during the last ten years in Bushehr. Materials and Methods: A total of 3210 slides related to appendiceal samples of appendectomy patients were collected in Bushehr over ten years (2012-2022) and examined in terms of microanatomy. The microscopic evaluation of the samples as well as the information contained in the patient health records were summarized and the collected data were analyzed in SPSS-16 software using the Chi-square test. Results: The frequency of appendicitis caused by E. vermicularis in the studied samples was 0.8%, showing a decreasing trend over the last years. There was a significant relationship between appendicitis caused by E. vermicularis and the gender and age of the patients, but there was no significant relationship with their place of residence. Conclusion: Considering the decreasing trend of appendicitis caused by Enterobius over the last few years in Bushehr, a role can be attributed to the COVID pandemic in this outcome. It is suggested to carry out preliminary evaluations for the early diagnosis of this parasitic infection, especially in infected areas, in order to eliminate unnecessary surgical interventions.

The involvement of kidney, perirenal fat, and ureter is a rare variant of inguinal hernia. We report a case of a 78-year-old man presenting with typical clinical signs of acute appendicitis. Ultrasonography and CT scan revealed ptosis of the right kidney with a major part of the perirenal capsule involved in a large right sided inguinal hernia with acute obstruction of the ureter and urostasis. Acute surgery was performed, involving resection of perirenal fat, liberation, resection, and neoimplantation of the ureter, and hernioplasty. The postoperative period was uneventful. This case illustrates diagnostic unpredictability of acute appendicitis as well as anatomic variety of inguinal hernias. [ABSTRACT FROM AUTHOR]

Background: Acute appendicitis is the most common surgical emergency in Ethiopian clinical practice. Although a multitude of scoring systems have been used in clinical practice, none have been universally validated. The purpose of this study was to validate the Raja Isteri Pengiran Anak Saleha Appendicitis (RIPASA) scoring system in the Ethiopian context. Methods: A total of 315 consecutive patients who presented with a presumptive diagnosis of acute appendicitis and were planned to undergo appendectomy were studied. All the studied patients had diagnostic sonography and underwent the RIPASA scoring system. The sensitivity, specificity, positive predictive value, and negative predictive value of RIPASA and ultrasound results with intraoperative gross examinations. Results: The mean age of the participants was 27.4 ± 11.5 years, with a male-to-female ratio of 1.6:1. The concordance between ultrasound and RIPASA for the diagnosis of acute appendicitis was 93.6%. The sensitivity, specificity, positive predictive value, and negative predictive value of RIPASA were 96.2%, 30.8%, 93.9%, and 42.1%, respectively. Similarly, the sensitivity, specificity, positive predictive value, and negative predictive value of ultrasound were 95.3%, 27.8%, 95.6%, and 26.3%, respectively. White cell count and RIPASA scores were weakly correlated with intraoperative stages of acute appendicitis, r(313) = 0.18, p = 0.001, and r(313) = 0.129, p = 0.022, respectively. The rate of a negative appendectomy was 6%. Conclusion: RIPASA and ultrasound had equivalent performance in the diagnosis of acute appendicitis. In both cases, the rate of negative appendectomy was low enough to validate RIPASA for clinical practice in low-income institutions where sonographic diagnosis by a conventionally trained radiologist is not available. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study is to identify risk factors associated with acute complicated appendicitis (CA) in children aged three years or younger, providing a theoretical foundation for the management and treatment of acute appendicitis (AA). Methods: A retrospective analysis was conducted on 135 pediatric patients with AA, admitted to the Department of General Surgery at Anhui Children's Hospital between December 2020 and December 2023, who underwent successful surgical treatment. Based on the intraoperative and postoperative pathological findings, patients were categorized into two groups: complicated appendicitis (CA) (n = 97 cases) and uncomplicated appendicitis (UA) (n = 38 cases). Clinical data including gender, age, weight, disease duration, preoperative white blood cell count (WCC), neutrophil granulocyte (NEUT) count, C-reactive protein (CRP) levels, total bilirubin (TBil) levels, procalcitonin (PCT) levels, calprotectin (Cal) levels, preoperative ultrasound results indicating the presence or absence of fecaliths, maximum appendix diameter, and pediatric appendicitis sore (PAS) were collected and analyzed. Comparative analysis was performed to investigate the differences between the groups and identify risk factors of CA. Results: The CA group exhibited significantly higher values in disease duration, CRP levels, PCT, Cal, presence of appendiceal fecaliths, maximum appendix diameter, and PAS compared to the UA group (P < 0.05). Multivariate analysis identified CRP levels, maximum appendix diameter, and PAS as independent risk factors for CA. Specifically, differences in CRP level (OR = 1.045, 95% CI:1.024 ~ 1.067, P < 0.001), PAS (OR = 1.768, 95% CI:1.086 ~ 2.879, P = 0.022), and maximum appendix diameter (OR = 1.860, 95% CI:1.085 ~ 3.191, P = 0.024) were significant. The area under the receiver operating characteristic curve values were 0.6776 for the PAS, 0.7663 for CRP, and 0.5604 for the maximum appendix diameter. Conclusion: CRP levels, PAS, and maximum appendix diameter are independent risk factors for CA in children under three years of age. These parameters are valuable for the early diagnosis of CA. [ABSTRACT FROM AUTHOR]

Introduction: Acute pain in the right lower quadrant during pregnancy is difficult to approach and acute appendicitis must be excluded. The complication rate in pregnant acute appendicitis increases as a result of delayed diagnosis due to physiological and anatomic changes. The systemic immune inflammatory index (SII), which includes several inflammatory tests, is considered to be a good indicator of acute inflammation. The aim of the present study was to investigate the diagnostic value of SII in the diagnosis of acute appendicitis and complicated appendicitis in pregnant women. Material-method: This was designed as a retrospective, single-center case-control study. This study was performed in pregnant women over 12 weeks of gestation who were diagnosed with acute appendicitis as indicated by pathology report and met the inclusion criteria. Vital parameters, demographic characteristics, laboratory values, presence of complicated appendicitis, and pathology reports were taken into analysis. Results: The present study was performed with 76 pregnant women, including 38 pregnant women with acute appendicitis and 38 pregnant women with healthy controls. SII had a sensitivity of 82.0% and specificity of 66.7% with a cut-off value of 840.13 in pregnant acute appendicitis cases (AUC: 0.790; 95% CI: 0.686–0.984; p < 0.001) and SII level was significantly higher in complicated appendicitis cases with a sensitivity and specificity of 66.7% and 91.3%, respectively, with a cut-off value of 2301.66 (AUC: 0.812; 95% CI: 0.665–0.958; p = 0.001). Conclusion: SII is a cost-effective, rapid, easily calculated, and powerful marker that can be used for the diagnosis of both acute and complicated appendicitis in pregnant patients. [ABSTRACT FROM AUTHOR]

Background/Objectives: In patients diagnosed with uncomplicated acute appendicitis (UAA), the absence of calcified deposits or stones, called appendicoliths, often leads to consideration of non-operative treatment (NOT), despite the notable treatment failure rate associated with this approach. Previous research has indirectly estimated the prevalence of appendicoliths to range between 15% and 38% retrospectively by CT scan, intraoperative palpation, and pathology report, thereby potentially missing certain concrements. Our hypothesis proposes that this reported prevalence significantly underestimates the occurrence of appendicoliths, which could explain the high failure rate of 29% of patients with appendicitis observed with NOT. Methods: In our prospective study, conducted with a cohort of 56 adult patients diagnosed with acute appendicitis (AA), we employed intraoperative extracorporeal incisions of the vermiform appendix, in addition to standard diagnostic methods. Results: Our findings revealed 50% more appendicoliths by intraoperative incision (n = 36, p < 0.001) compared to preoperative imaging (n = 24). Appendicoliths were present in 71.4% (n = 40, p < 0.001) of AA patients. Conclusions: These results suggest that conventional diagnostic procedures plausibly underestimate the actual prevalence of appendicoliths, potentially elucidating the frequent treatment failures observed in NOT approaches applied to patients with UAA. [ABSTRACT FROM AUTHOR]

Acute appendicitis is a typical surgical emergency worldwide and one of the common causes of surgical acute abdomen in the elderly. Accurately diagnosing and differentiating acute appendicitis can assist clinicians in formulating a scientific and reasonable treatment plan and providing high-quality medical services for the elderly. In this study, we validated and analyzed the different performances of various machine learning models based on the analysis of clinical data, so as to construct a simple, fast, and accurate estimation method for the diagnosis of early acute appendicitis. The dataset of this paper was obtained from the medical data of elderly patients with acute appendicitis attending the First Affiliated Hospital of Anhui University of Chinese Medicine from January 2012 to January 2022, including 196 males (60.87%) and 126 females (39.13%), including 103 (31.99%) patients with complicated appendicitis and 219 (68.01%) patients with uncomplicated appendicitis. By comparing and analyzing the prediction results of the models implemented by nine different machine learning techniques (LR, CART, RF, SVM, Bayes, KNN, NN, FDA, and GBM), we found that the GBM algorithm gave the optimal results and that sensitivity, specificity, PPV, NPV, precision, recall, F1 and brier are 0.9167, 0.9739, 0.9429, 0.9613, 0.9429, 0.9167, 0.9296, and 0.05649, respectively. The GBM model prediction results are interpreted using the SHAP technology framework. Calibration and Decision curve analysis also show that the machine learning model proposed in this paper has some clinical and economic benefits. Finally, we developed the Shiny application for complicated appendicitis diagnosis to assist clinicians in quickly and effectively recognizing patients with complicated appendicitis (CA) and uncomplicated appendicitis (UA), and to formulate a more reasonable and scientific clinical plan for acute appendicitis patient population promptly. [ABSTRACT FROM AUTHOR]

Copyright of Revista Foco (Interdisciplinary Studies Journal) is the property of Revista Foco and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Introduction: The aim of this study was to find statistically valid criteria to preoperatively divide acute appendicitis into simple and complicated to enable surgeons to administer the most appropriate antibiotic prophylaxis/therapy before surgery. Materials and methods: We retrospectively reviewed a cohort of patients who underwent appendectomy from January 2022 to December 2023. Patients included were 0–14 years of age. Exclusion criteria included patients who underwent interval appendectomy or concurrent procedures at the same time of appendectomy. We divided patients into two groups: simple (group S) and complicated (group C) appendicitis according to intraoperative finding. Generalized linear model (GLM) with logit function was developed to identify the predictive variables of the type of appendicitis (S vs C) in terms of CRP value, neutrophils percentage and WBC count adjusted for age and sex of patients. Finally, principal component analysis (PCA) was carried out to identify the cutoff value of statistically significant variables found in the previous analysis. Results: One hundred and twenty patients were eligible (N female = 49, N male = 71) for the study. 74 and 46 patients were included in groups S and C, respectively. In a preliminary analysis using univariate and multivariate GLM, only CRP (p value = < 0.001) and neutrophils percentage (p value = 0.02) were predictive variables for the type of appendicitis. The GLM shows a statistical lower value of CRP (adjusted odds ratio [OR] per unit, 0.17 [95% CI, 0.08–0.39]) and neutrophil percentage (adjusted OR per unit, 0.37 [95% CI, 0.16–0.86]) in the S group compared to C adjusted to age and sex. PCA analysis revealed a P-ROC cutoff of 4.2 mg/dl and 80.1 of CRP value (AUC = 84%) and neutrophil percentage (AUC = 70%), respectively. Conclusions: We will perform a prospective study giving preoperative prophylactic cefazolin to patients with a CRP value under 4.2 mg/dl and amoxicillin–clavulanate therapy to patient with CRP value over 4.2 mg/dl. [ABSTRACT FROM AUTHOR]

Amyand’s hernia is a rare disorder characterized by the presence of the vermiform appendix within an inguinal hernia. It is predominantly found in the pediatric age group, and its occurrence in adulthood is rare. Hence, a systematic analysis of twenty-six case reports of Amyand’s hernia published in the peer-reviewed literature in the year 2023 is presented with emphasis on variables including age of the patient, gender, clinical presentation, side of the inguinal hernia, imaging modalities used for evaluation, achievement of preoperative diagnosis or otherwise, classification, appendix management, hernia management, surgical approach, and outcomes. [ABSTRACT FROM AUTHOR]

Background: Cumulative sum (CUSUM) analysis is a valuable tool for quantifying the learning curve of surgical teams by detecting significant changes in operative length. However, there is limited research evaluating the learning curve of laparoscopic techniques in low-resource settings. The objective of this study is to evaluate the learning curve for laparoscopic appendectomy within a single surgical team in Senegal. Methods: This was a single-center prospective study conducted from May 1, 2018, to August 31, 2023 of patients who underwent laparoscopic appendectomy at a tertiary care institution in West Africa. The AAST classification was used to describe the severity of appendicitis. Parameters studied included age, sex, operative length, conversion rate, and postoperative outcomes. To quantify the learning curve, CUSUM analysis of operative length was performed. Results: A total of 81 patients were included. The mean age was 26.7 years (range 11–70 years) with a sex ratio of 1.9. Pre-operative severity according to AAST was Grade I in 75.4% (n = 61), Grade III in 7.4% (n = 6), Grade IV in 6.1% (n = 5), and Grade V in 11.1% (n = 9). Conversion occurred in 5 cases (6.1%). The average operative length was 76.8 min (range 30–180 min) and the average length of hospitalization was 2.7 days (range 1–13 days). Morbidity was observed in 3.7% (n = 3) and there were no deaths. The CUSUM analysis showed that a steady operative length was achieved after 28 procedures, with decreasing operative lengths thereafter. Conclusion: Surgeons in our setting overcame the learning curve for laparoscopic appendectomy after performing 28 procedures. Moreover, laparoscopic appendectomy is safe and feasible throughout the learning curve. CUSUM analysis should be applied to other laparoscopic procedures and individualized by surgical teams to improve surgical performance and patient outcomes in low-resource settings. [ABSTRACT FROM AUTHOR]

Reliance on International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) diagnosis codes may misclassify perforated appendicitis with resultant research, fiscal, and public health implications. We aimed to improve the accuracy of administrative data for perforated appendicitis classification relying on ICD-10-CM codes from 2015 to 2018. We conducted a retrospective study of randomly sampled patients aged ≤18 years diagnosed with acute appendicitis from eight children's hospitals. Patients were identified using the Pediatric Health Information System, and true perforation status was determined by medical record review. We developed two algorithms by leveraging Pediatric Health Information System data elements and data mining (DM) approaches. The two developed algorithm performance was compared against algorithms that exclusively relied on ICD-10-CM codes using area under the curve and other measures. Of 1051 clinically validated encounters that were included, 383 (36.4%) patients were identified to have perforated appendicitis. The two algorithms developed using DM approaches primarily leveraged ICD-10-CM codes and length of stay. DM-developed algorithms had a significantly higher accuracy than algorithms relying exclusively on ICD-10-CM (P value < 0.01): sensitivity and specificity for DM-developed algorithms were 0.86-0.88 and 0.95-0.97, respectively, which were overall higher than algorithms that relied on only ICD-10-CM. This study provides an algorithm that can improve the accuracy of perforated appendicitis classification using commonly available elements in administrative data. We recommend that this algorithm is used in future appendicitis classification to ensure valid reporting, hospital-level benchmarking, and fiscal or public health assessments. [ABSTRACT FROM AUTHOR]

The vermiform appendix, once deemed vestigial and largely overlooked in medical circles, has recently captured renewed attention for its potential immunological functions. This review comprehensively explores various aspects related to the appendix, including its historical marginalization, anatomical characteristics, and emerging insights into its role in immunity. Discussion extends to the clinical relevance of the appendix in human health and disease. Additionally, evolutionary perspectives shed light on its persistence across species and potential adaptive significance. As researchers explore further into its immunological roles, new avenues for investigation emerge, promising to uncover further complexities in human physiology. This review aims to present a nuanced understanding of the appendix, encouraging ongoing exploration and recognition of its importance within the human body. [ABSTRACT FROM AUTHOR]

Purpose: To validate whether the introduction of the ratio of the cross diameters on the transverse section of the appendix (RATIO) ≤ 1.18 is useful for improving the ultrasound diagnosis of acute appendicitis (AA). Methods: Data from 220 patients with AA and 110 patients with a normal appendix were retrospectively studied. The RATIO ≤ 1.18, maximal outer diameter (MOD) > 6 mm, and a combination of RATIO ≤ 1.18 and MOD > 6 mm were used for predicting AA. The area under the receiver operating characteristic curve (AUC), sensitivity, specificity, positive and negative predictive values (PPV and NPV) were calculated. Results: The RATIO ≤ 1.18, MOD > 6 mm, and a combination of RATIO ≤ 1.18 and MOD > 6 mm for predicting AA showed a sensitivity of 90, 100, and 90%; specificity of 79.1, 27.3, and 88.2%; and AUC of 0.845, 0.636, and 0.891, respectively. When comparing the outcomes between MOD > 6 mm and a combination of MOD > 6 mm and RATIO ≤ 1.18, the specificity and PPV increased from 27.3 to 88.2% and 73.3 to 93.8%, respectively (all P < 0.0001). The sensitivity and NPV decreased from 100 to 90% and 100 to 81.5%, respectively (all P < 0.0001). The AUC increased from 0.636 to 0.891 (P < 0.0001). When comparing the AUC of MOD > 6 mm, and a combination of RATIO ≤ 1.18 and MOD > 6 mm for predicting AA with the AUC in a previous study, there were no significant differences between each other (all P > 0.05). Conclusion: Introducing the RATIO ≤ 1.18 for the evaluation of AA can improve the diagnostic performance and significantly increase specificity. [ABSTRACT FROM AUTHOR]

The appendix is known to have varying locations and extents in relation to the cecum, to which it is attached in the main gastrointestinal tract. These variations have significant implications in terms of the varying clinical presentation of appendicitis, which may deviate from the classical presentation in the right iliac fossa and thus delay diagnosis. Knowledge of the different positions of the appendix helps in identifying the relatively common pathology of appendicitis, which may occur even beyond the confines of the right iliac fossa. This imaging case series depicts the spectrum of variations in the locations of the appendix as seen on Computed Tomography (CT) in a comprehensive though simpler way. The types of appendix illustrated in this imaging case series include the medial appendix with its subtypes (postileal-3, pelvic-2), subcecal (3), retrocecal (2), paracecal (1), and prececal appendix (1). In cases of the acute abdomen where appendicitis is suspected and if the appendix is not identified or only partly traced in the right iliac fossa, attempts should be made to trace the entire appendix in unconventional locations in the abdomenpelvis. Such a scenario might be more likely if the patient is only experiencing distal appendicitis. [ABSTRACT FROM AUTHOR]

Introduction. Organ transposition due to situs inversus (SI) is a rare condition that makes the diagnosis of acute appendicitis difficult. This condition entails that the patient' symptoms and physical examination findings may be atypical, which requires the use of images for diagnostic confirmation in most cases. Clinical cases. Three cases of appendicitis in patients diagnosed with situs inversus are described. Two of them had a known medical history, while the third case was diagnosed intraoperatively. Results. In two patients it was decided to undergo laparoscopic surgery without additional diagnostic images. The patients progressed satisfactorily. Conclusion. Appendicitis should always be considered in the differential diagnoses in patients with pain in the left iliac fossa. It is essential to diagnose and treat appendicitis effectively to minimize associated complications. The importance of the anamnesis and the examiner's clinical suspicion are vital in these cases, which can be confirmed with diagnostic images. There may be cases where the patient's clinical condition does not allow diagnostic imaging studies to be performed, increasingly supports the use of the laparoscopic approach. It is recommended to consider the laparoscopic approach in the first instance, since it allows us to confirm the diagnosis of situs inversus totalis in case the history is unknown and facilitates timely management of the emergency. [ABSTRACT FROM AUTHOR]

Diverticular disease of the appendix is usually an incidental finding. Appendiceal diverticulitis presents with abdominal pain in the right iliac fossa, with symptoms in the acute phase indistinguishable from those of acute appendicitis. Radiological diagnosis of appendiceal diverticulitis is based on the identification of a diverticula arising from the appendix but can be difficult in the setting of inflammatory changes or complication as perforation which can obscure his presence. Its incidence is underestimated due to lack of awareness of its subtle radiological findings and clinical-radiological overlap with appendicitis. The resultant delayed diagnosis is associated with significant complications including a six- fold increase in the risk of perforation. [ABSTRACT FROM AUTHOR]

Copyright of Turkish Journal of Trauma & Emergency Surgery / Ulusal Travma ve Acil Cerrahi Dergisi is the property of KARE Publishing and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background The aim of this study was to determine and compare the miRNA profile in the immune response with the parasite in pediatric patients with acute appendicitis caused by Enterobius vermicularis and in pediatric patients with enterobiasis. Methods A total of 30 tissue samples, which were operated with the diagnosis of pediatric acute appendicitis in the last 10 y and Enterobius vermicularis was detected by histopathological findings, were analyzed. In addition, blood samples were taken from 30 pediatric patients diagnosed with enterobiasis for this study. The miRNAs that activate T and B cells were evaluated by a quantitative real-time PCR, statistically calculated within ΔΔCt values, and fold changes were evaluated by Welch's T test, in which p<0.5 was considered to be significant. Results It was found that 48 out of 136 (35.3%) miRNAs differed between the pediatric patient and healthy control groups. It was determined that 22 (57.9%) of the different miRNAs were T cell activating miRNAs and 26 (68.4%) were B cell activating miRNAs. While there was a significant difference in miRNA values activating T cells in two patient groups (p<0.01), there was no significant difference in miRNA values activating B cells (p>0.01). Conclusions In the study, although Enterobius vermicularis was the causative agent in both patient groups, it was revealed that the immune response of patients with acute appendicitis was more affected than enterobiasis patients. [ABSTRACT FROM AUTHOR]

Background: Schistosomiasis is one of the endemic parasitic diseases in many developing countries. Despite this, appendicitis secondary to schistosomiasis is an uncommon condition even in some endemic areas. Schistosomal appendicitis, an incidentally discovered appendicitis associated with schistosomiasis histological findings, affects young males predominantly. Timely diagnosis and treatment, including appendectomy and anti-helminthic therapy, are crucial. Case report: A 24-year-old Sudanese male patient presented with abdominal pain. Diagnosed with acute appendicitis, he underwent appendectomy, revealing appendix inflammation with Schistosoma ova in histopathology. Abdominal ultrasound detected no complications. Weakly positive Schistosoma serology was noted, but stool and urine analysis showed no infection evidence. Prescribed praziquantel, patient had 3-year post-op follow-up without complications. Conclusions: This case report underscores the significance of including schistosomiasis in the differential diagnosis of appendicitis, particularly in regions where the disease is endemic. It underscores the necessity of histopathological evaluations for accurate diagnosis, emphasizing the potential implications for clinical practice in similar settings. [ABSTRACT FROM AUTHOR]

Backgrounds: Acute Appendicitis (AA) is one of the most common surgical emergencies worldwide. This study aims to investigate the predictive performances of 6 different Machine Learning (ML) algorithms for simple and complicated AA. Methods: Data regarding operated AA patients between 2012 and 2022 were analyzed retrospectively. Based on operative findings, patients were evaluated under two groups: perforated AA and none-perforated AA. The features that showed statistical significance (p < 0.05) in both univariate and multivariate analysis were included in the prediction models as input features. Five different error metrics and the area under the receiver operating characteristic curve (AUC) were used for model comparison. Results: A total number of 1132 patients were included in the study. Patients were divided into training (932 samples), testing (100 samples), and validation (100 samples) sets. Age, gender, neutrophil count, lymphocyte count, Neutrophil to Lymphocyte ratio, total bilirubin, C-Reactive Protein (CRP), Appendix Diameter, and PeriAppendicular Liquid Collection (PALC) were significantly different between the two groups. In the multivariate analysis, age, CRP, and PALC continued to show a significant difference in the perforated AA group. According to univariate and multivariate analysis, two data sets were used in the prediction model. K-Nearest Neighbors and Logistic Regression algorithms achieved the best prediction performance in the validation group with an accuracy of 96%. Conclusion: The results showed that using only three input features (age, CRP, and PALC), the severity of AA can be predicted with high accuracy. The developed prediction model can be useful in clinical practice. Highlights: ML models can be used in all parts of medical treatments. With good features, it would be useful in the prediction of surgical pathologies. ML models are strong predictors of the severity of acute appendicitis. With simple and easily found tools, the Logistic Regression algorithm predicted the severity of acute appendicitis with 96% accuracy. This study also used an unseen data set to validate the results of training data. This increased the reliability of the prediction models. [ABSTRACT FROM AUTHOR]

Objectives—The objective was to compare the effectiveness of observation in standard-of-care computed tomography (CT) in adult patients with suspected acute appendicitis (AA). Methods—Patients with clinically suspected AA and inconclusive diagnosis after primary clinical examination, laboratory examination, and transabdominal ultrasound (TUS) were eligible for the study, and they were randomized (1:1) to parallel groups: observation-group patients were observed for 8–12 h and then, repeated clinical and laboratory examinations and TUS were performed; CT group (control group) patients underwent abdominopelvic CT scan. The study utilized Statistical Analysis System 9.2 for data analysis, including tests, logistic regression, ROC analysis, and significance evaluation. Patients were enrolled in the study at Vilnius University Hospital Santaros Klinikos in Lithuania between December 2018 and June 2021. Results—A total of 160 patients (59 men, 101 women), with a mean age of 33.7 ± 14.71, were included, with 80 patients in each group. Observation resulted in a reduced likelihood of a CT scan compared with the CT group (36.3% vs. 100% p < 0.05). One diagnostic laparoscopy was performed in the observation group; there were no cases of negative appendectomy (NA) in the CT group. Both conditional CT and observation pathways resulted in high sensitivity and specificity (97.7% and 94.6% vs. 96.7% and 95.8%). Conclusions—Observation including the repeated evaluation of laboratory results and TUS significantly reduces the number of CT scans without increasing NA numbers or the number of complicated cases. [ABSTRACT FROM AUTHOR]

Introduction: Appendicectomy remains the standard treatment for appendicitis. There is a lack of clarity on the timeframe in which surgery should be performed to avoid unfavourable outcomes. Aim: To perform a systematic review and network meta-analysis to evaluate the impact the (1)time-of-day surgery is performed (2), time elapsed from symptom onset to hospital presentation (patient time) (3), time elapsed from hospital presentation to surgery (hospital time), and (4)time elapsed from symptom onset to surgery (total time) have on appendicectomy outcomes. Methods: A systematic review was performed as per PRISMA-NMA guidelines. The time-of-day which surgery was done was divided into day, evening and night. The other groups were divided into < 24 h, 24–48 h and > 48 h. The rate of complicated appendicitis, operative time, perforation, post-operative complications, surgical site infection (SSI), length of stay (LOS), readmission and mortality rates were analysed. Results: Sixteen studies were included with a total of 232,678 patients. The time of day at which surgery was performed had no impact on outcomes. The incidence of complicated appendicitis, post-operative complications and LOS were significantly better when the hospital time and total time were < 24 h. Readmission and mortality rates were significantly better when the hospital time was < 48 h. SSI, operative time, and the rate of perforation were comparable in all groups. Conclusion: Appendicectomy within 24 h of hospital admission is associated with improved outcomes compared to patients having surgery 24–48 and > 48 h after admission. The time-of-day which surgery is performed does not impact outcomes. [ABSTRACT FROM AUTHOR]

The identification of pediatric appendicitis is challenging due to the lack of specific markers thereby several factors are included in the diagnostic process such as abdominal pain, ultrasonography and altered laboratory parameters (C reactive protein, absolute neutrophil cell number and white blood cell number). The glycosylation pattern of serum N-glycome was analyzed in this study of 38 controls and 40 patients with pediatric appendicitis. The glycans were released by enzymatic deglycosylation followed by fluorescent labeling and solid-phase extraction. The prepared samples were analyzed by hydrophilic interaction liquid chromatography with fluorescence and mass-spectrometric detection. The generated data were analyzed by multiple statistical tests involving the most important laboratory parameters as well. Significant differences associated with the examined patient groups were revealed suggesting the potential use of glycosylation analysis supporting the detection of pediatric appendicitis. [ABSTRACT FROM AUTHOR]

Background: Acute appendicitis is a common abdominal emergency observed in emergency departments (ED). Distinguishing between uncomplicated and complicated appendicitis is important in determining a treatment strategy. Serum soluble vascular cell adhesion molecule-1 (VCAM-1) is an inflammatory biomarker. We aimed to determine the role of VCAM-1 in predicting complicated appendicitis in children. Methods: Pediatric patients with suspected appendicitis admitted to the ED were enrolled in this prospective study. Pre-surgical serum VCAM-1 was tested in children with acute appendicitis within 72 h of symptoms (from day 1 to day 3). Serum VCAM-1 levels were further analyzed and compared between patients with and without complicated appendicitis. Results: Among the 226 pediatric appendicitis patients, 70 had uncomplicated appendicitis, 138 had complicated appendicitis, and 18 had normal appendices. The mean serum VCAM-1 levels in patients with perforated appendicitis were higher than in those with simple appendicitis (p < 0.001). On day 1 to day 3, the mean VCAM-1 levels in patients with complicated appendicitis were all significantly higher than in those with uncomplicated appendicitis (all p < 0.001). Conclusion: Serum VCAM-1 levels may be helpful in differentiating uncomplicated and complicated appendicitis in children and could predict appendiceal perforation. [ABSTRACT FROM AUTHOR]

Mucosal-associated invariant T (MAIT) cells are antimicrobial T cells abundant in the gut, but mechanisms for their migration into tissues during inflammation are poorly understood. Here, we used acute pediatric appendicitis (APA), a model of acute intestinal inflammation, to examine these migration mechanisms. MAIT cells were lower in numbers in circulation of patients with APA but were enriched in the inflamed appendix with increased production of proinflammatory cytokines. Using the patient-derived appendix organoid (PDAO) model, we found that circulating MAIT cells treated with inflammatory cytokines elevated in APA up-regulated chemokine receptors, including CCR1, CCR3, and CCR4. They exhibited enhanced infiltration of Escherichia coli-pulsed PDAO in a CCR1-, CCR2-, and CCR4-dependent manner. Close interactions of MAIT cells with infected organoids led to the PDAO structural destruction and death. These findings reveal a previously unidentified mechanism of MAIT cell tissue homing, their participation in tissue damage in APA, and their intricate relationship with mucosal tissues during acute intestinal inflammation in humans. [ABSTRACT FROM AUTHOR]

Purpose: Surgery wait times after diagnosis of appendicitis are an important factor influencing the success of a patient's treatment. The proposed study will be a quantitative multicenter retrospective cohort design with the primary aim of assessing the difference between appendicectomy wait times between rural and urban hospitals in Western Australia and the effect of this on operative outcomes. Selected outcome measures will be examined by time from initial presentation at an emergency department to the patient being diagnosed and then time of diagnosis to surgery being performed. The secondary aim is to compare rates of negative appendicectomies between hospitals. Methods: Appendicectomy patients will be identified from operating room register by medical student data collectors; then, each respective hospital's emergency room data collection will subsequently be accessed to complete case report forms based on demographics and clinical findings, pre-operative investigations, and management and follow-up. Case report forms with > 95% completeness will be accepted for pooled analysis. The expected duration of retrospective data collection will be 8 months. This study RGS6483 has received HREC approval by the Royal Perth Hospital HREC Ethics Committee, with a waiver of consent obtained and the HREC was notified of amendments to the protocol made on April 21, 2024. Dissemination of results. Data will be collected and stored online through a secure server running the Research Electronic Data Capture (REDCap) web application. No patient-identifiable data will be entered into the system. Results will subsequently be shared via scientific journal publication and presentation at relevant meetings. [ABSTRACT FROM AUTHOR]

Objective: To investigate the predictive value of neutrophil-to-lymphocyte ratio (NLR) for early perforation of the appendix in patients with acute appendicitis (AA). Methods: Two hundred and 80eighty patients with the first episode of AA within 48 hours and not yet treated with antibiotics were included in this study retrospectively; divided into two groups by the presence or absence of perforation. The clinical data, traditional inflammatory indexes, and NLR were compared between the two groups. The predictive value of inflammatory indexes on the early appendiceal perforation was explored. Results: Patients in the perforated group were older, with higher blood WBC, NEU% and NLR, lower LYM% and PLT, higher serum CRP and PCT, and longer hospitalization time. Multivariate regression analysis revealed that high WBC, NEU%, NLR, CRP, PCT, and low LYM% were independent risk factors for early appendiceal perforation. The ROC curves revealed that the predictive value of WBC, CRP, and PCT for early appendiceal perforation was low. NLR, LYM%, and NEU% had a higher predictive value, with AUC values of 0.947, 0.928, and 0.920, respectively. NLR had the highest predictive value. The diagnostic Cut-off value of NLR is 10.83 with a sensitivity of 0.963, and a specificity of 0.850. Conclusion: NLR can be used as an effective and sensitive predictive maker of early appendiceal perforation in AA patients. It is easy to generate from existing routine clinical laboratory testing for AA and can be included in complete blood count (CBC) as a routine or add-on value. [ABSTRACT FROM AUTHOR]

Intra-abdominal infections (IAIs) are an important cause of morbidity and mortality in hospital settings worldwide. The cornerstones of IAI management include rapid, accurate diagnostics; timely, adequate source control; appropriate, short-duration antimicrobial therapy administered according to the principles of pharmacokinetics/pharmacodynamics and antimicrobial stewardship; and hemodynamic and organ functional support with intravenous fluid and adjunctive vasopressor agents for critical illness (sepsis/organ dysfunction or septic shock after correction of hypovolemia). In patients with IAIs, a personalized approach is crucial to optimize outcomes and should be based on multiple aspects that require careful clinical assessment. The anatomic extent of infection, the presumed pathogens involved and risk factors for antimicrobial resistance, the origin and extent of the infection, the patient's clinical condition, and the host's immune status should be assessed continuously to optimize the management of patients with complicated IAIs. [ABSTRACT FROM AUTHOR]

Introduction: The purpose of this analysis was to investigate the most appropriate duration of postoperative antibiotic treatment to minimize the incidence of intraabdominal abscesses and wound infections in patients with complicated appendicitis. Materials and methods: In this retrospective study, which included 396 adult patients who underwent appendectomy for complicated appendicitis between January 2010 and December 2020 at the University Hospital Erlangen, patients were classified into two groups based on the duration of their postoperative antibiotic intake: ≤ 3 postoperative days (group 1) vs. ≥ 4 postoperative days (group 2). The incidence of postoperative intraabdominal abscesses and wound infections were compared between the groups. Additionally, multivariate risk factor analysis for the occurrence of intraabdominal abscesses and wound infections was performed. Results: The two groups contained 226 and 170 patients, respectively. The incidence of postoperative intraabdominal abscesses (2% vs. 3%, p = 0.507) and wound infections (3% vs. 6%, p = 0.080) did not differ significantly between the groups. Multivariate analysis revealed that an additional cecum resection (OR 5.5 (95% CI 1.4–21.5), p = 0.014) was an independent risk factor for intraabdominal abscesses. A higher BMI (OR 5.9 (95% CI 1.2–29.2), p = 0.030) and conversion to an open procedure (OR 5.2 (95% CI 1.4–20.0), p = 0.016) were identified as independent risk factors for wound infections. Conclusion: The duration of postoperative antibiotic therapy does not appear to influence the incidence of postoperative intraabdominal abscesses and wound infections. Therefore, short-term postoperative antibiotic treatment should be preferred. [ABSTRACT FROM AUTHOR]

Background: Neoplasms derived from remnant appendix are rarely described, with most cases arising from the appendiceal "stump". Here, we present two surgical cases of appendiceal neoplasms derived from appendiceal "tip" remnants. Case presentation: The first patient was a 71-year-old man who had undergone laparoscopic appendectomy for acute appendicitis 12 years prior. During appendectomy, the appendiceal root was ligated, but the appendix was not completely removed due to severe inflammation. At the most recent presentation, computed tomography (CT) was performed to examine choledocholithiasis, which incidentally revealed a cystic lesion of approximately 90 mm adjacent to the cecum. A retrospective review revealed that the cystic lesion had increased in size over time, and laparoscopic ileocecal resection was performed. Pathology revealed no continuity from the appendiceal orifice to the cyst, and a diagnosis of low-grade appendiceal mucinous neoplasm (LAMN) was made from the appendiceal tip remnant. The patient was discharged without complications. The second patient was a 65-year-old man who had undergone surgery for peritonitis due to severe appendicitis 21 years prior. During this operation, the appendix could not be clearly identified due to severe inflammation; consequently, cecal resection was performed. He was referred to our department with a chief complaint of general fatigue and loss of appetite and a cystic lesion of approximately 85 mm close to the cecum that had increased over time. CT showed irregular wall thickening, and malignancy could not be ruled out; therefore, laparoscopic ileocecal resection with D3 lymph node dissection was performed. The pathological diagnosis revealed mucinous adenocarcinoma (TXN0M0) arising from the remnant appendiceal tip. The patient is undergoing follow-up without postoperative adjuvant chemotherapy, with no evidence of pseudomyxoma peritonei or cancer recurrence for 32 months postoperatively. Conclusions: If appendicitis-associated inflammation is sufficiently severe that accurate identification of the appendix is difficult, it may remain on the apical side of the appendix, even if the root of the appendix is ligated and removed. If the appendectomy is terminated incompletely, it is necessary to check for the presence of a residual appendix postoperatively and provide appropriate follow-up. [ABSTRACT FROM AUTHOR]

The aim of this study was to analyze the role of thiol/disulfide homeostasis (TDH) parameters as an indicator of oxidative stress in acute appendicitis (AA). PubMed, EMBASE, Web of Science, and Scopus databases were systematically searched. Studies reporting on TDH in AA (both complicated and uncomplicated cases) were included. The comparator group were healthy controls. The TDH domain was compared between the groups using anti-oxidant parameters, namely native thiol and total thiol levels, and native thiol/total thiol ratio; and oxidant parameters, namely disulfide level, disulfide/native thiol ratio, and disulfide/total thiol ratio. The statistical analysis was performed using a random-effects model. The methodological quality of the studies was assessed utilizing the Newcastle–Ottawa scale. Eleven studies with a total of 926 subjects, comprising 457 patients with uncomplicated appendicitis, 147 with complicated appendicitis, and 322 healthy controls were included. Our study demonstrated significantly increased oxidative stress in AA as compared to healthy controls in all TDH parameters and significantly lower total thiol levels in complicated AA as compared to uncomplicated AA. Due to a poor methodological quality in five out of eleven studies, future prospective studies with adequate power are essential to validate these observations and refine the diagnostic approaches to AA. [ABSTRACT FROM AUTHOR]

The diagnosis of acute appendicitis and concurrent surgery referral is primarily based on clinical presentation, laboratory and radiological imaging. However, utilizing such an approach results in as much as 10–15% of negative appendectomies. Hence, in the present study, we aimed to develop a machine learning (ML) model designed to reduce the number of negative appendectomies in pediatric patients with a high clinical probability of acute appendicitis. The model was developed and validated on a registry of 551 pediatric patients with suspected acute appendicitis that underwent surgical treatment. Clinical, anthropometric, and laboratory features were included for model training and analysis. Three machine learning algorithms were tested (random forest, eXtreme Gradient Boosting, logistic regression) and model explainability was obtained. Random forest model provided the best predictions achieving mean specificity and sensitivity of 0.17 ± 0.01 and 0.997 ± 0.001 for detection of acute appendicitis, respectively. Furthermore, the model outperformed the appendicitis inflammatory response (AIR) score across most sensitivity–specificity combinations. Finally, the random forest model again provided the best predictions for discrimination between complicated appendicitis, and either uncomplicated acute appendicitis or no appendicitis at all, with a joint mean sensitivity of 0.994 ± 0.002 and specificity of 0.129 ± 0.009. In conclusion, the developed ML model might save as much as 17% of patients with a high clinical probability of acute appendicitis from unnecessary surgery, while missing the needed surgery in only 0.3% of cases. Additionally, it showed better diagnostic accuracy than the AIR score, as well as good accuracy in predicting complicated acute appendicitis over uncomplicated and negative cases bundled together. This may be useful in centers that advocate for the conservative treatment of uncomplicated appendicitis. Nevertheless, external validation is needed to support these findings. [ABSTRACT FROM AUTHOR]

Introduction: Surgery for acute appendicitis has been associated with significant morbidity. This study aimed to determine the factors associated with early inhospital adverse outcomes following surgery for acute appendicitis in Uganda. Methods: This was a multicentre, prospective cohort in which early inhospital outcome following surgery for acute appendicitis was assessed at 4 regional referral hospitals in Uganda. The occurrence of complications during the admission period was documented as well as the length of hospital stay. Factors associated with adverse outcomes were determined using Poisson regression. Results: Of the 102 patients who underwent surgery for acute appendicitis, the majority were males 79(77.5%) with a mean age of 23.8(SD = 12.5) years. The perforated appendix was seen in 26 (25.5%) patients. Post-operative complications occurred in 21(20.6%) with the commonest being surgical site infection in 19(18.6%) patients. The median length of hospital stay was 3(IQR = 3–4) days with 43(42.2%) staying in hospital for more than 3 days. The presence of anemia (Hb < 8) (aRR = 1.376, CI = 1.159–1.634, P = < 0.001) and having a perforated appendix (aRR = 1.263, CI = 1.026–1.555, P = 0.027) were independently associated with occurrence of complications while being HIV positive (aRR = 1.379, CI = 1.105–1.721, P = 0.005) and having a perforated appendix (aRR = 1.258, CI = 1.019–1.554, P = 0.033) were independently associated with prolonged hospital stay. Conclusion: Community education about early presentation is still required in order to reduce the number of patients that present late which should, in turn, reduce the risk of complications and length of hospital stay. [ABSTRACT FROM AUTHOR]

Aim: Delays in care may be a driver of inequities in perforated appendicitis rates. The goal of this study was to explore potential causes of delay in care for children with perforated appendicitis. Methods: We conducted an interview study of caregivers of children admitted with perforated appendicitis to a children's hospital between December 2022 and March 2023. Semi‐structured interviews based on an iteratively revised interview guide were conducted in‐person during the child's admission. All interviews were transcribed, coded and underwent a process of thematic analysis. Results: We reached thematic saturation after 12 interviews. The median age for children was 13.5 years, 50% were male, 83% of caregivers self‐identified as White, and one interview required an interpreter. Through thematic analysis, four major themes for potential causes of delay emerged. The first theme of symptom recognition includes delays related to recognising the symptoms, their severity and the need for medical evaluation. The second theme – accessing care – describes delays that occur after a decision was made to seek care until the child was evaluated. The third theme includes delays that occur in making the diagnosis after evaluation. The last theme captures potential delays in definitive treatment after a diagnosis of appendicitis is made. Conclusion: We identify four major themes from the patient and family perspective, each with multiple sub‐themes, for potential delays in definitive care for children with perforated appendicitis. Additional research is needed to further characterise these potential delays and quantify their role in contributing to inequities in perforation rates. [ABSTRACT FROM AUTHOR]

Purpose: Despite their similar clinical characteristics, appendiceal diverticulitis (AD) and acute appendicitis (AA) are pathologically distinct. This study compared the clinical features of AD and AA and identified relevant risk factors. Methods: Patients who underwent appendectomy with a preoperative diagnosis of either AD or AA were categorized based on histopathological findings. The two groups were compared in terms of various clinical factors. Results: Among the 854 patients included in the study, a histopathological evaluation revealed 49 and 805 cases of AD and AA, respectively. A univariate analysis demonstrated that AD was more prevalent than AA among older, taller, and heavier males. A multivariate analysis revealed that male sex, a white blood cell (WBC) count < 13.5 × 103/μL, an eosinophil count ≥ 0.4%, and a mean corpuscular volume (MCV) ≥ 91.6 fL were significant factors differentiating AD from AA. In addition, pathological AD emerged as an independent risk factor for abscess and/or perforation. Conclusions: AD was associated with an older age, robust physique, and significant risk of abscess and/or perforation despite a low WBC count. In addition to imaging modalities, the preoperative factors of male sex, a WBC count < 13.5 × 103/μL, an eosinophil count ≥ 0.4%, and a MCV ≥ 91.6 fL may be useful for distinguishing AD from AA. [ABSTRACT FROM AUTHOR]

Background: The role of Enterobius vermicularis infestation in the context of appendicitis is largely overlooked, but Enterobius vermicularis is considered an unexpected and significant appendicectomy finding. The aim of this study was to investigate the frequency of Enterobius vermicularis findings in appendectomies and to evaluate the clinical and histopathologic features of patients with Enterobius vermicularis-associated acute appendicitis and those with appendiceal Enterobius vermicularis infestation. Methods: The medical records of all children who underwent an appendectomy in two large pediatric centers in Croatia between 1 January 2009 and 1 January 2024 were retrospectively reviewed. Of 6359 appendectomies, 61 (0.96%) children were diagnosed with Enterobius vermicularis on histopathology and included in further analysis. The groups were compared with regard to demographic characteristics, laboratory values, clinical features and histopathological findings. Results: The incidence of enterobiasis fluctuated slightly in the individual study years, but was constant overall. The median age of all patients was 11 years (IQR 8.5, 13), with females predominating (60.7%). Acute appendicitis was observed in 34% of the appendiceal species. The patients with Enterobius vermicularis infestation, without appendicitis, were younger (9 years (IQR 8, 13) vs. 12 years (IQR 10, 15); p = 0.020), had longer duration of symptoms (36 h (IQR, 12, 48) vs. 24 h (IQR, 12, 36); p = 0.034), lower body temperature (37 °C (IQR 36.8, 37.4) vs. 37.6 °C (IQR, 37, 38.6) p = 0.012), lower Appendicitis Inflammation Response (AIR) score (3 (IQR 2, 5) vs. 7 (IQR 5, 9.5) p < 0.001), lower incidence of rebound tenderness (57.1% vs. 20%; p = 0.003) and less frequent vomiting (12.5% vs. 47.6%; p = 0.004) compared to the patients with Enterobius vermicularis-associated acute appendicitis. Acute inflammatory markers in the laboratory showed significantly higher values in the group of patients with acute appendicitis: C-reactive protein (p = 0.009), White blood cells (p = 0.001) and neutrophils (p < 0.001). Eosinophilia was not found in any of the groups, although eosinophil counts were significantly higher in children who had Enterobius vermicularis infestation than in those with Enterobius vermicularis-related appendicitis (2.5% (IQR 0.9, 4.3) vs. 1.8% (IQR 0.7, 2.1); p = 0.040). Conclusions: Pediatric surgeons should consider Enterobius vermicularis infestation as a differential diagnosis when removing a vermiform appendix. Younger age, longer duration of symptoms, lower body temperature, lower AIR score, lower diameter of the appendix and normal laboratory inflammatory markers could predict Enterobius vermicularis infection in children presenting with right iliac fossa pain and avoid unnecessary appendectomy. [ABSTRACT FROM AUTHOR]

Globally, acute appendicitis has an estimated lifetime risk of 7–8%. However, there are numerous controversies surrounding the management of acute appendicitis, and the best treatment approach depends on patient characteristics. Non-operative management (NOM), which involves the utilization of antibiotics and aggressive intravenous hydration, and surgical appendectomy are valid treatment options for healthy adults. NOM is also ideal for poor surgical candidates. Another important consideration is the timing of surgery, i.e., the role of interval appendectomy (IA) and the possibility of delaying surgery for a few hours on index admission. IA refers to surgical removal of the appendix 8–12 weeks after the initial diagnosis of appendicitis. It is ideal in patients with a contained appendiceal perforation on initial presentation, wherein an initial nonoperative approach is preferred. Furthermore, IA can help distinguish malignant and non-malignant causes of acute appendicitis, while reducing the risk of recurrence. On the contrary, a decision to delay appendectomy for a few hours on index admission should be made based on the patients' baseline health status and severity of appendicitis. Post-operatively, surgical drain placement may help reduce postoperative complications; however, it carries an increased risk of drain occlusion, fistula formation, and paralytic ileus. Furthermore, one of the most critical aspects of appendectomy is the closure of the appendiceal stump, which can be achieved with the help of endoclips, sutures, staples, and endoloops. In this review, we discuss different aspects of management of acute appendicitis, current controversies in management, and the potential role of endoscopic appendectomy as a future treatment option. [ABSTRACT FROM AUTHOR]

Background: Appendicitis is an extremely common disease with a variety of medical and surgical treatment approaches. A multidisciplinary expert panel was convened to develop evidence-based recommendations to support clinicians and patients in decisions regarding the diagnosis and treatment of appendicitis. Methods: A systematic review was conducted from 2010 to 2022 to answer 8 key questions relating to the diagnosis of appendicitis, operative or nonoperative management, and specific technical and post-operative issues for appendectomy. The results of this systematic review were then presented to a panel of adult and pediatric surgeons. Evidence-based recommendations were formulated using the GRADE methodology by subject experts. Results: Conditional recommendations were made in favor of uncomplicated and complicated appendicitis being managed operatively, either delayed (>12h) or immediate operation (<12h), either suction and lavage or suction alone, no routine drain placement, treatment with short-term antibiotics postoperatively for complicated appendicitis, and complicated appendicitis previously treated nonoperatively undergoing interval appendectomy. A conditional recommendation signals that the benefits of adhering to a recommendation probably outweigh the harms although it does also indicate uncertainty. Conclusions: These recommendations should provide guidance with regard to current controversies in appendicitis. The panel also highlighted future research opportunities where the evidence base can be strengthened. [ABSTRACT FROM AUTHOR]

Background: When pregnant patients present with nonobstetric pathology, the physicians caring for them may be uncertain about the optimal management strategy. The aim of this guideline is to develop evidence-based recommendations for pregnant patients presenting with common surgical pathologies including appendicitis, biliary disease, and inflammatory bowel disease (IBD). Methods: The Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) Guidelines Committee convened a working group to address these issues. The group generated five key questions and completed a systematic review and meta-analysis of the literature. An expert panel then met to form evidence-based recommendations according to the Grading of Recommendations Assessment, Development, and Evaluation approach. Expert opinion was utilized when the available evidence was deemed insufficient. Results: The expert panel agreed on ten recommendations addressing the management of appendicitis, biliary disease, and IBD during pregnancy. Conclusions: Conditional recommendations were made in favor of appendectomy over nonoperative treatment of appendicitis, laparoscopic appendectomy over open appendectomy, and laparoscopic cholecystectomy over nonoperative treatment of biliary disease and acute cholecystitis specifically. Based on expert opinion, the panel also suggested either operative or nonoperative treatment of biliary diseases other than acute cholecystitis in the third trimester, endoscopic retrograde cholangiopancreatography rather than common bile duct exploration for symptomatic choledocholithiasis, applying the same criteria for emergent surgical intervention in pregnant and non-pregnant IBD patients, utilizing an open rather than minimally invasive approach for pregnant patients requiring emergent surgical treatment of IBD, and managing pregnant patients with active IBD flares in a multidisciplinary fashion at centers with IBD expertise. [ABSTRACT FROM AUTHOR]

Background: Acute appendicitis remains the most common surgical emergency worldwide. There has been a low uptake of laparoscopic appendicectomy in the South African public sector. Preoperative identification of cases of uncomplicated appendicitis that are amenable to a laparoscopic approach may facilitate the implementation of laparoscopic appendicectomy programs in training hospitals. With limited access to preoperative imaging, alternative strategies for this preoperative prediction are needed. Methods: A retrospective audit of patients over the age of 12 years with a histologically confirmed diagnosis of acute appendicitis over a 5‐year period was performed. Patients were categorized as uncomplicated or complicated appendicitis and C‐reactive protein (CRP) and white cell count (WCC) reviewed. Receiver operating characteristics curves were constructed for these blood tests and acute appendicitis severity. Youden's J statistic was used to determine optimal cut off values for diagnosing complicated appendicitis. Results: 358 patients had confirmed appendicitis and complete blood results. Of these, 189 (52.79%) had complicated appendicitis with a 40.22% perforation rate. Median CRP in uncomplicated and complicated groups were 68 mg/L (IQR 19–142) and 216 mg/L (IQR 103–313) with an area under the curve (AUC) of 0.75 (95% CI: 0.70–0.80). The median WCC in the two groups were 12.6 × 109 cells/L (IQR 9.9–15.6) and 14.4 × 109 cells/L (IQR 11.5–18.28) with an AUC of 0.61 (95% CI: 0.56–0.67). The optimal cut off value for CRP was found to be 110 mg/L with a sensitivity of 74.74% and specificity of 69.23%. Conclusion: A cutoff value of 110 mg/dl CRP can distinguish patients with early appendicitis from those with complicated disease and when used in conjunction with clinical assessment may help identify patients in whom laparoscopic appendicectomy is appropriate. [ABSTRACT FROM AUTHOR]

Background: Controversies remain on the diagnostic strategy in suspected AA, considering the different settings worldwide. Material and Methods: A prospective observational international multicentric study including patients operated for suspected AA with a definitive histopathological analysis was conducted. Three groups were analyzed: (1) No radiology; (2) Ultrasound, and (3) Computed tomography. The aim was to analyze the performance of three diagnostic schemes. Results: Three thousand and one hundred twenty three patients were enrolled; 899 in the no radiology group, 1490 in the US group, and 734 in the CT group. The sex ratio was in favor of males (p < 0.001). The mean age was lower in the no radiology group (24 years) compared to 28 and 38 years in US and CT‐scan groups, respectively (p < 0.001). Overall, the negative appendectomy rate 3.8%: no radiology group (5.1%) versus US (2.9%) and CT‐scan (4.1%) (p < 0.001). The sensitivity and specificity analysis showed the best balance in clinical evaluation + score + US. These data reach the best results in those patients with an equivocal Alvarado score (4–6). Inverse probability weighting (IPW), showed as the use of ultrasound, is significantly associated with an increased probability of formulating the correct diagnosis (p 0.004). In the case of a CT scan, this association appears weaker (p 0.08). Conclusion: The association of clinical scores and ultrasound seems the best strategy to reach a correct preoperative diagnosis in patients with clinical suspicion of AA, even in those population subgroups where the clinical score may have an equivocal result. This strategy can be especially useful in low‐resource settings worldwide. CT‐scan association may improve the detection of patients who may potentially be submitted to conservative treatment. [ABSTRACT FROM AUTHOR]

Background: Epiploic appendagitis (EPA) is an uncommon emergency surgical condition that causes acute abdominal pain, rendering a list of differential diagnoses. Therefore, careful examination and imaging tools are required. EPA is a self‐limiting condition that can be resolved in 1–2 weeks and rarely needs surgical intervention. Its low incidence makes EPA less well‐known among the public and some medical professionals, and it is frequently under‐diagnosed. We aimed to explore the incidence, clinical presentation, modalities of imaging to diagnose and options for treating EPA. Methods: An observational retrospective analysis was conducted between 2016 and 2022 at a tertiary hospital in an Arab Middle Eastern country. Results: There were 156 EPA cases diagnosed over six years, with a mean age of 33 years. Males represented 82% of the cohort. The entire cohort was treated non‐operatively except for eight patients who had surgical intervention using open or laparoscopic surgery. The diagnosis was made by a computerized tomographic scan (CT). However, plain X‐ray, abdominal ultrasound, and magnetic resonance imaging (MRI) were performed initially in a few selected cases to rule out other conditions. No specific blood test indicated EPA; however, a histopathology examination was diagnostic. No mortality was reported in the study cohort. Conclusion: This is the most extensive study analyzing EPA patients from the Middle East. EPA is a rare and mostly self‐limiting acute abdominal disorder; however, early ultrasound and CT scan can pick it up quickly after a high index of suspicion. [ABSTRACT FROM AUTHOR]

Nonoperative management (NOM) of uncomplicated appendicitis (UA) has been increasingly utilized in recent years. The aim of this study was to describe nationwide trends of sociodemographic characteristics, outcomes, and costs of patients undergoing medical versus surgical management for UA. The 2018-2019 National (Nationwide) Inpatient Sample was queried for adults (age ≥18 y) with UA; diagnosis, as well as laparoscopic and open appendectomy, were defined by the International Classification of Diseases, 10th Revision, Clinical Modification codes. We examined several characteristics, including cost of care and length of hospital stay. Among the 167,125 patients with UA, 137,644 (82.4%) underwent operative management and 29,481 (17.6%) underwent NOM. In bivariate analysis, we found that patients who had NOM were older (53 versus 43 y, P < 0.001) and more likely to have Medicare (33.6% versus 16.1%, P < 0.001), with higher prevalence of comorbidities such as diabetes (7.8% versus 5.5%, P < 0.001). The majority of NOM patients were treated at urban teaching hospitals (74.5% versus 66.3%, P < 0.001). They had longer LOS's (5.4 versus 2.3 d, P < 0.001) with higher inpatient costs ($15,584 versus $11,559, P < 0.001) than those who had an appendectomy. Through logistic regression we found that older patients had up to 4.03-times greater odds of undergoing NOM (95% CI: 3.22-5.05, P < 0.001). NOM of UA is more commonly utilized in patients with comorbidities, older age, and those treated in teaching hospitals. This may, however, come at the price of longer length of stay and higher costs. Further guidelines need to be developed to clearly delineate which patients could benefit from NOM. • NOM of UA continues to be increasingly utilized. • Between 2018 and 19, 17.6% of UA were found to undergo NOM. • Older patients have up to 4.03 times greater odds of undergoing NOM for UA. • Patients with higher comorbidities have 1.36 times greater odds of undergoing NOM for UA. [ABSTRACT FROM AUTHOR]

Introduction: Acute appendicitis (AA) is a significant cause of emergency admissions among university students aged over 20 years. Students experience high demands during their undergraduate studies, often leading them to postpone mealtimes or rest breaks. Here, with the assistance of ChatGPT, we present two cases of medical students with AA who delayed their surgical treatment due to exams. Clinical cases: Two young patients (a 23-year-old female and a 20-year-old male) presented with severe abdominal pain, anorexia, and general discomfort. They had high C-reactive protein levels and white blood cell counts, as well as an ultrasound showing an enlarged appendix. Despite the confirmed diagnosis of appendicitis through abdominal ultrasound, both patients decided to postpone hospitalization and surgery due to university exams. They subsequently underwent uncomplicated emergency laparoscopic appendectomy. The clinical report of both cases was successfully addressed with ChatGPT, using the initial data from the medical record, and coherent discussions regarding patient management and follow-up were generated. Conclusions: The surgical intervention applied in both cases of AA was successful, and although both patients recovered without issues, delaying surgery can increase the risk of complications. It is necessary to educate the university population about the importance of immediate medical attention for the treatment of AA. ChatGPT appears to be a useful tool for organizing clinical information and improving discussions on therapeutic management. [ABSTRACT FROM AUTHOR]