scholarly journals A comparison of intra-operative diagnosis to histopathological diagnosis of acute appendicitis in paediatric and adult cohorts: an analysis of over 1000 patients

2021 ◽  
Author(s):  
Johnathon Harris ◽  
Christina A. Fleming ◽  
Paul N. Stassen ◽  
Daniel Mullen ◽  
Helen Mohan ◽  
...  
Keyword(s):  
Acute Appendicitis ◽  
Histopathological Diagnosis ◽  
Open Appendicectomy ◽  
Normal Appendix ◽  
Macroscopic Appearance ◽  
Surgical Department ◽  
Suspected Appendicitis ◽  
Final Histological Diagnosis ◽  
Negative Appendicectomy ◽  
Operating Surgeon

Abstract Background Appendicitis is a common general surgical emergency. The role of removing a normal appendix is debated. However, this relies on accurate intra-operative diagnosis of a normal appendix by the operating surgeon. This study aimed to compare surgeon’s intra-operative assessment to final histological result acute appendicitis in paediatric and adult patients. Methods All patients who underwent appendicectomy over a 14-year period in a general surgical department were identified using the prospective Lothian Surgical Audit system and pathology reports retrieved to identify final histological diagnosis. Open appendicectomy was selected to examine, as the routine practise at our institution is to remove a normal appendix at open appendicectomy. Results A total of 1035 open appendicectomies were performed for clinically suspected appendicitis. Sensitivity of intra-operative diagnosis of appendicitis with operating surgeon was high at 95.13% with no difference between trainee and consultant surgeon or between adult and paediatric cases. Specificity of intra-operative diagnosis was lower in the paediatric group (32.58%) than in the adult group (40.58%). Women had a higher rate of negative appendicectomy than men. Conclusion The results of this study highlight some discordance between histological evidence of acute appendicitis and intra-operative impression. Therefore other clinical variables and not just macroscopic appearance alone should be used when deciding to perform appendicectomy.

EP.FRI.615 Assessing the reliability of the Adult Appendicitis Score in managing patients with suspected acute appendicitis

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Carry Zheng ◽  
Shiela Lee ◽  
Steven Brown ◽  
Venkat Kanakala
Keyword(s):  
Acute Appendicitis ◽  
Risk Group ◽  
Pathological Finding ◽  
High Risk Group ◽  
Histological Diagnosis ◽  
Suspected Appendicitis ◽  
Tertiary Centre ◽  
Negative Appendicectomy ◽  
Age Range ◽  
Suspected Acute Appendicitis

Abstract Aims To evaluate the effectiveness of using a clinical prediction tool in the management of suspected acute appendicitis Methods Retrospective data was collected on patients undergoing appendicectomy at a single tertiary centre from November 2019 to June 2020. Inclusion criteria were all patients aged 18 and above undergoing diagnostic laparoscopy for suspected appendicitis. Exclusion criteria were all patients that had a pathological finding other than appendicitis at laparoscopy. The pre operative AAS score at first presentation was calculated and patients grouped into low(0-10), intermediate(11-15), and high(16 and above) risk. These groups were then compared to the histological findings. Results A total of 74 patients were included, 44 male and 30 female. The age range was from 18 to 83, with a median age of 36. Of 10 patients in the low risk group, 4 (40%) had appendicitis on histology. 36 out of 40 (90%) patients in the intermediate risk group had appendicitis and 100% of the 24 patients in the high risk group. Pearson’s coefficient showed a significant correlation between the AAS risk (low, intermediate, and high) and the histological diagnosis of appendicitis (r = 0.48, p = 0.000016). Conclusions Our study did show a positive correlation between the AAS risk stratification and histological diagnosis. Based on our findings we would recommend the adoption of this score in assessing patients with suspected acute appendicitis and minimising the negative appendicectomy rate.

scholarly journals 1185 Acute Paediatric Appendicitis(AA)-Decreasing The Negative Rate Of Appendicectomy

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
G Karagiannidis ◽  
O Toma ◽  
E Mallidis ◽  
F Youssef
Keyword(s):  
Data Collection ◽  
Conservative Treatment ◽  
Observational Study ◽  
Acute Appendicitis ◽  
First Trimester ◽  
Operative Management ◽  
Open Appendicectomy ◽  
Number Of Children ◽  
Negative Rate ◽  
Negative Appendicectomy

Abstract Aim The COVID -19 pandemic has forced changes in the management of Acute Appendicitis (AA), such as prioritising conservative management and avoiding laparoscopic procedures. This observational study aims to monitor and reduce the negative rate of paediatric appendicectomy and optimise the acute paediatric management following the newly introduced workflow. Method Retrospective patient data collection via electronic sources for all paediatric patients(0-16 years old) admitted with AA between March 23rd and October 31st 2020. Results During this period 74 patients were admitted with suspected AA. Conservative treatment was performed in 16 (22%) patients and operative management in 58 (78%), of which 15 (26%) had an open appendicectomy, while 43 (74%) underwent laparoscopic appendicectomy. The first trimester the negative appendicectomy rate was 25%, which dropped to 11% because of the newly introduced paediatric AA workflow and the more extensive use of US in the context of diagnosis of appendicitis.In the beginning of the study, the percentage of US scanning was 72% and was increased to 90% after the end of the 3rd period. Conclusions The introduction of the paediatric AA workflow and the more extensive use of US helped to decrease the percentage of negative rate of paediatric appendicecomy the number of children who underwent unnecessary operation.

scholarly journals 353 AIR Score Based Management of Appendicitis

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
A Carlile
Keyword(s):  
Acute Appendicitis ◽  
Ct Scan ◽  
Acute Abdomen ◽  
General Surgery ◽  
Diagnostic Laparoscopy ◽  
Open Appendicectomy ◽  
Common Cause ◽  
Retrospective Audit ◽  
Negative Appendicectomy ◽  
Score Risk

Abstract Introduction Appendicitis is the most common cause of an acute abdomen. Approximately 7% of the population will be affected at some point. The development of AIR has been developed to aid diagnosis and decreasing the number of negative appendectomies while also safely identifying those who have developed appendicitis. Aim This retrospective audit, which aims to assess the effects of the introduction of AIR score risk on the negative appendicectomy rate of patients admitted to Taranaki Base Hospital. Method All patients under General Surgery receiving open appendicectomy, laparoscopic appendicectomy or diagnostic laparoscopy for evaluation or treatment of appendicitis from January 1st 2017 – December 31st 2018. Results The negative appendicectomy rate dropped 11.1% after introduction of the AIR score, we also noted a decrease in CT scan use. Discussion Our results suggest that the Air score could be used as an adjunct to the clinical diagnosis of acute appendicitis.

scholarly journals Incidence of Negative Appendicectomy: Correlation Between Clinical, Peroperative and Histopathological Findings

2017 ◽  
Vol 42 (3) ◽  
pp. 142-146
Author(s):  
Mohammad Zillur Rahman ◽  
Johirul Islam ◽  
Md. Hasanuzzaman ◽  
Ahsan Habib ◽  
Avisak Bhattachari
Keyword(s):  
Acute Appendicitis ◽  
Correct Diagnosis ◽  
Reproductive Age ◽  
Histological Evaluation ◽  
Diagnostic Tools ◽  
Histopathological Findings ◽  
Suspected Appendicitis ◽  
Female Patients ◽  
Male Patients ◽  
Negative Appendicectomy

Appendicitis is one of the most difficult diagnostic problems to confront the emergency physician and it is the most common intra-abdominal condition requiring emergency surgery. The term “Negative appendicectomy” used for operation done for suspected appendicitis, in which the appendix is found to be normal on histological evaluation. The study aimed to find out the incidence of negative appendicectomy evaluating the correlation between clinical, per-operative and histopathological findings. It was a prospective study of 100 cases clinically diagnosed as acute appendicitis selected over a period of one year (July 2006 to June 2007) from different surgical ward of Mymensingh Medical College Hospital. The study revealed a negative appendicectomy rate of 12%. Moreover, in all cases of acute appendicitis, there was a well established bias towards male patients and young male patients constituted the majority of the cases. But the rate of negative appendicectomy found to be higher in female patients, which is 15.9% as compared to only 8.92% male patients. In addition, among female patients differential diagnostic difficulties encountered in females of reproductive age group. More emphasis on technology at the expense of clinical evaluation is certainly responsible for the diminish in accuracy of diagnosis. The diagnosis of acute appendicitis remains essentially clinical, requiring a mixture of observation, clinical acumen and accurate use of diagnostic tools.  A correct diagnosis is certainly important than a rapid diagnosis.

scholarly journals 904 Can Patients with Acute Appendicitis be Ambulated Safely?

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
S O'Brien ◽  
L Armstrong
Keyword(s):  
Acute Appendicitis ◽  
Significant Proportion ◽  
Initial Assessment ◽  
Efficacy And Safety ◽  
Oral Antibiotics ◽  
Surgical Service ◽  
Open Appendicectomy ◽  
Suspected Appendicitis ◽  
Uncomplicated Appendicitis ◽  
The Uk

Abstract Introduction During the COVID-19 pandemic, surgical service and practice has been adjusted in order to reduce acute surgical admissions. Acute appendicitis accounts for a significant proportion surgical admissions in the UK. Intercollegiate general surgery guidance during the COVID-19 pandemic advised appendicitis should be managed conservatively, or with an open appendicectomy if indicated. Our aim was to determine the efficacy and safety of our ambulation service in the conservative management of acute uncomplicated appendicitis. Method Data was collected prospectively from 30th March 2020 – 16th August 2020 on all patients presenting with suspected appendicitis. Stable patients with clinically suspected or CT-proven appendicitis were discharged with oral antibiotics as per trust guidance. Readmissions for ambulated patients were recorded. Results 190 patients presented with suspected appendicitis (range 5-71years). 49.4% patients were deemed suitable for ambulation on initial assessment, 22% of which had a CT confirmed diagnosis on discharge. 65% of the ambulated patients underwent a telephone review within a 72-hour window. 13.8% of patients represented within a 30-day period, 7.4% of which proceeded to appendicectomy. Conclusions Patients with uncomplicated appendicitis can be safely managed with antibiotics out of hospital, with low representation rates.

scholarly journals 920 Long Term Outcomes After Resection of A 'Normal' Appendix

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
F Hammett ◽  
S Ali ◽  
R Adair ◽  
M Peter ◽  
B Dobbins ◽  
...  
Keyword(s):  
Cost Effective ◽  
Normal Appendix ◽  
Suspected Appendicitis ◽  
Operative Outcomes ◽  
Primary Surgery ◽  
Cost Effective Method ◽  
Negative Appendicectomy ◽  
The Cost

Abstract Introduction Recent studies have suggested that there should be diagnostic confirmation of appendicitis prior to surgical resection to reduce the rate of negative (normal) appendicectomy. There are few long-term analyses of morbidity after negative appendicectomy. Method All appendicectomy specimens removed for suspected appendicitis from June 2010 to August 2015 at a single-centre surgical unit were identified. Patients with a histologically 'normal' appendix were analysed. Demographics, pre-operative and operative details and post-operative outcomes (Clavien-Dindo system) were recorded. Minimum follow-up was 5 years. Results There were 1977 patients. Most (1938 patients, 98%) had a laparoscopic procedure. There were 241 normal specimens (12.1%); none of these patients had pre-operative CT imaging. Thirty-two patients had at least one re-admission in the 5 years after surgery; 12 of these patients had multiple re-admissions (range, 2-5 re-admissions). 22 patients (69%) had a re-admission within 30 days after primary surgery. 4 patients (<1%) required further surgery and mortality was 0%. 6 patients (2%) had a Grade III complication, and none had a Grade IV complication. Conclusions There was low long-term morbidity after negative appendicectomy in this study. The cost of confirming a normal diagnosis by way of mandatory pre-operative CT does not represent a cost-effective method of management.

scholarly journals Prevalence and risk factors of Appendicitis at Surgery Department of a Tertiary Care Hospital in Pakistan

2021 ◽  
Vol 15 (8) ◽  
pp. 2497-2499
Author(s):  
Laraib Zafar ◽  
Kiran Maqbool ◽  
Maj Uzma Javed Gul ◽  
Ishfaq Ahmad Khan ◽  
Arshid Mahmood
Keyword(s):  
Risk Factors ◽  
Acute Appendicitis ◽  
Cross Sectional Study ◽  
Histopathological Diagnosis ◽  
Care Hospital ◽  
Age Group ◽  
Sectional Study ◽  
Cross Sectional ◽  
Female Ratio ◽  
Surgical Department

Background: Appendicitis needs immediate surgical intervention based on indication in the pediatric age group. Among high-risk young children, the prevalence of pre-existing perforation ranges from 30% to 75%. Aim: To investigate the prevalence and risk factors for appendicitis in the inpatient surgical department. Place and Duration: Study was conducted at surgical department of Combined Military Hospital, Rawalakot for the period of six months from October 2020 to March 2021. Materials and Methods: A single-center cross-sectional study was conducted on 102 patients with acute appendicitis diagnosed and confirmed by Ultrasonography among the patients admitted to the surgical department during October 2020 to March 2021. Pretested questionnaire were used to collect and record the necessary information. Results: The sample size of 102 patients had 61 (60%) males and 41 (40%) were females. Appendicitis patients were divided into four age groups: 10-19 years 16 (15.7%), 20-29 years 19 (32.35%), 30-39 years 15 (14.7%), 40-49 years 14 (13.7%), and 50-59 years 7 (.6.8 %). The male-to-female ratio was 3:2. (60 %, 40 %). The most common complaints are abdominal pain (100%), vomiting (55.12%), and fever (87.21%). Based on histopathological diagnosis, the categorical distributions of appendicitis were Acute Appendicitis (48.10%), Lymphoid Hyperplasia (25.50%), and Resolving Appendicitis (47.05%). Conclusion: The prevalence of acute appendicitis is more common in males especially in the age group of 20-29 years based on histological diagnosis. Keywords: Appendicitis, Cross-sectional Study

scholarly journals TP9.2.5Routine ultrasound in paediatric appendicitis is highly accurate and substantially reduces negative appendicectomy rate

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Alexander Darbyshire ◽  
Ashley Towers ◽  
Simon Toh ◽  
Stuart Mercer
Keyword(s):  
Length Of Stay ◽  
High Sensitivity ◽  
Small Bowel Resection ◽  
Normal Appendix ◽  
Suspected Appendicitis ◽  
Highly Sensitive ◽  
General Surgeons ◽  
Ovarian Pathology ◽  
Operative Ultrasound ◽  
Negative Appendicectomy

Abstract Aims Our centre routinely uses ultrasound in adults to confirm diagnosis of appendicitis. This study investigated its use in the diagnosis of suspected appendicitis in children and its impact on management. Methods Retrospective cohort study of children (5-16 years) managed by general surgeons with suspected appendicitis during 2019. Primary outcomes were ultrasound use. Secondary outcomes were diagnosis, length of stay, complications and negative appendicectomy rate. Results A total of 193 children were admitted with suspected appendicitis. The majority underwent an ultrasound scan (169/193 [88%]) which identified an inflammed appendix or secondary-inflammation in nearly all cases of appendicitis (65/71 [91%] and 5/71 [7%] respectively). A normal appendix was identified in more than half of children not diagnosed with appendicitis (53/95 [56%]), with the rest showing an ovarian pathology (3/95 [3%]) or normal scan (39/95 [41%]). Ultrasound had high sensitivity (92% [CI 83-97%]) and specificity (100% [CI 96-100%]) for appendicitis. The majority of children diagnosed with appendicitis were treated with laparoscopic appendicectomy (75/85 [88%]) and a minority medically-managed (10/75 [12%]). One appendix mass was medically-managed, and two Meckels Diverticulitis underwent a laparoscopic small bowel resection. Negative appendicectomy rate was extremely low (2/77 [2.5%]). Post-operative complication rate was low (6%). Median length of stay was short for appendicitis and all other diagnoses (2days [IQR 2.2] and 1day [IQR 0] respectively). Discussion The majority of children with suspected appendicitis underwent pre-operative ultrasound, which was highly sensitive and specific for appendicitis. Negative appendicectomy rate was extremely low, and likely related to routine pre-operative imaging.

scholarly journals The role of ultrasonography in acute appendicitis

2017 ◽  
Vol 4 (5) ◽  
pp. 1769
Author(s):  
Yashwant R. Lamture ◽  
Varsha P. Gajbhiye ◽  
Vinay V. Shahapurkar
Keyword(s):  
Data Analysis ◽  
Acute Appendicitis ◽  
Crucial Role ◽  
Study Data ◽  
Normal Appendix ◽  
Chronic Appendicitis ◽  
Expert Radiologist ◽  
Negative Appendicectomy ◽  
Rule Out

Background:Acute appendicitis is the most common surgical emergency. Inspite of new investigations, mainstay of diagnosis depends on clinical sign and symptoms, laboratory and USG (ultrasonography) of abdomen. Out all these investigations USG is having a crucial role in a diagnosis of it. Hence this study was undertaken to prove its efficacy.Methods: This study was conducted in 418 patients with 186 females and 251 males. Patients were of acute appendicitis operated for appendicectomy were included in the study. Data analysis was done by Stata statistic software. Before surgery patients were subjected for necessary investigations including USG.Results:The mean age was 18.8 (range 8-83) years. Normal appendix found in 22 cases, hence negative appendicectomy rate was 6.6%.  Chronic appendicitis was found in 28 patients. Different pathology was found in 1 in the form of carcinoid of appendix (0.24%) but treated by appendicectomy. USG abdomen in present study showed sensitivity of 88.6% and specificity 92% with PPV and NPV was 98% and 52.3%, frequency reports were s/o acute appendicitis in 337 patients and normal in 82 subjects.Conclusions:It conclude that USG is very important tool to diagnose and rule out appendicitis and its complications like perforation or peritonitis. Its liberal use by expert radiologist can help to reduce negative appendicectomy rate.

scholarly journals EP.FRI.241 Negative appendicectomy rate and role of biomarkers in predicting the severity of acute appendicitis

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Cher Pin So ◽  
Nicholas Bradley ◽  
Andrew B C Crumley ◽  
Michael Samuel James Wilson
Keyword(s):  
Acute Appendicitis ◽  
Perforated Appendicitis ◽  
Grading System ◽  
Histopathological Analysis ◽  
Normal Appendix ◽  
Single Centre ◽  
Exact Test ◽  
Negative Appendicectomy ◽  
Appendiceal Perforation

Abstract Aim Acute appendicitis is the most common general surgical emergency. A recent consensus study has proposed a 10% negative appendicectomy rate. We aimed to determine the negative appendicectomy rate in our centre whilst evaluating the role of biomarkers in predicting the severity of appendicitis. Methods A single-centre retrospective analysis of consecutive laparoscopic appendicectomies from 2019-2020 was performed. Patients were categorised by severity using AAST grading system. Kruskal-Wallis test was used to compare biomarkers levels (WCC, CRP, bilirubin, neutrophil:lymphocyte ratio (NLR) and platelet:lymphocyte ratio (PLR)). T-test, ROC curve and Fisher’s exact test were used to differentiate between perforated and non-perforated appendicitis and negative appendicectomy rate. WCC ≥11, CRP ≥50, bilirubin ≥21, NLR ≥6.4 and PLR ≥153 were the cut-off values. Negative appendicitis was defined as normal appendix at histopathological analysis.   Results 224 patients were included; mean age 33.7 years, 57.1% were male. 17 patients (7.6%) had negative appendicectomy.  CRP, NLR, bilirubin and PLR increase with AAST score (P < 0.001).  WCC ≥11 (p < 0.001) and NLR ≥6.4 (p = 0.007) predicted acute appendicitis. WCC (p = 0.018), CRP (p < 0.001), bilirubin (p < 0.001), NLR (p < 0.001), PLR (p = 0.002) were predictive for appendiceal perforation. Conclusion 7.6% negative appendicectomy rate in our centre is below the recommended standard of 10% and lower than other centres. In our centre, raised WCC and NLR were predictive of acute appendicitis. WCC, CRP, bilirubin, NLR and PLR may be used to distinguish between perforated and non-perforated appendicitis. Our results add to the conflicting body of evidence relating to biomarkers and the severity of appendicitis.

Sign in / Sign up

Export Citation Format

Share Document