Evaluation of preoperative clinical and serological determinations in complicated acute appendicitis: A score for predicting complicated appendicitis

Abstract Objective The 11 March 2020 the World Health Organisation considered the COVID-19 Infection a pandemic disease. Between March and May 2020, the region of southern Switzerland was affected by the first pandemic peak, which was managed by dividing hospitals in Covid and non Covid facilities and by reducing elective surgery. At the end of the pandemic peak hospitals returned to their original structure but there was concern as to possible avoidance of former COVID facilities by patients because of fear of contracting of COVID-19 infection. For acute situations such as acute appendicitis, this could imply a delay of treatment. The aim of this retrospective study is to analyse the increment in incidence of complicated appendicitis in the post-pandemic period at our institution. Methods Clinical data of patients who underwent appendectomies in the period before and after the COVID-19 pandemic were analysed and compared. Diagnosis was based histopathological examination and/or on intra-operative or CT findings. Complicated appendicitis was defined as the presence of perforated or gangrenous appendicitis on histopathology or the presence of an abscess on CT scan. The incidence of complicated appendicitis, the time between onset of symptoms and patient admission (TOSA), the initial inflammatory blood tests and the complication rate was compared between the two periods. Results 79 patients were included in the study, 31 in the post-COVID-19 peak group (A), April - October 2020, and 48 in the pre-pandemic group (B), April - October 2019. Incidence of complicated appendicitis was significantly higher in group A (55% vs 14% p = 0.02). These findings correlate with a greater TOSA (mean time 35 hours vs 17 hours, p = 0.01) and higher inflammatory values in the initial blood test, (mean WBC count 14.8 G/l vs 12.9 G/l, p = 0.08 and mean CRP value 73 mg/l vs 43 mg/l, p = 0.01) in group A. Conclusion Our data show a clear increase of incidence of complicated acute appendicitis after the pandemic peak in our hospital. Indeed patients tended to wait longer to visit our emergency department after the pandemic peak. One explanation is a possible fear by the patients of contracting COVID-19 infection in a former COVID hospital. Management of surgical emergencies during and after a pandemic peak phase should take into account the fact that patients may wait longer to visit a doctor thus aggravating the degree of their disease.

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Leucocyte count in children with complicated and uncomplicated acute appendicitis: a comparative study

International Surgery Journal ◽

10.18203/2349-2902.isj20195178 ◽

2019 ◽

Vol 6 (12) ◽

pp. 4308

Author(s):

Liya Joseph

Keyword(s):

Acute Appendicitis ◽

Leucocyte Count ◽

Tertiary Care ◽

Age Groups ◽

Complicated Appendicitis ◽

Total Leucocyte Count ◽

Chi Square ◽

Uncomplicated Appendicitis ◽

Uncomplicated Acute Appendicitis ◽

Complicated Acute Appendicitis

Background: Identification of complicated and uncomplicated acute appendicitis is important in children. In acute appendicitis, along with clinical evaluation and staging, many laboratory tests have been used. The aim of the study was to compare total leucocyte count in children with uncomplicated and complicated acute appendicitis in different age groups.Methods: Retrospective cohort study was performed in children who underwent appendicectomy, in a Government tertiary care institution between January 2017 and December 2018. 206 patients were divided into complicated and uncomplicated appendicitis. Total leucocyte count at time of admission was compared according to age. Unpaired t test and Chi-square test were used for statistical analysis.Results: There were 136 males and 70 females. 107 patients (51.94%) had complicated and 99 (48.06%) had uncomplicated appendicitis. Mean leucocyte count per µl in uncomplicated appendicitis was 18993±3540 in <5 years, 17155±3386 in 5-10 years and 15833±3613 in 10-15 years. The mean leucocyte count for complicated appendicitis was 19974±3658 in <5 years, 17727±4487 in 5-10 years and 17220±3411 in 10-15 years age group. In 10-15 years group, patients with complicated acute appendicitis had statistically significant higher values of mean total leucocyte count.Conclusions: Total leucocyte count can be used as marker of severity of acute appendicitis in children older than 10 years. In children with clinical suspicion of acute appendicitis, total leucocyte count >20000 per µl signifies complicated appendicitis in all age groups.

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Complicated Acute Appendicitis during COVID-19 Pandemic: The Hidden Epidemic in Children

European Journal of Pediatric Surgery ◽

10.1055/s-0041-1723992 ◽

2021 ◽

Author(s):

Carlos Delgado-Miguel ◽

Antonio J. Muñoz-Serrano ◽

Miriam Miguel-Ferrero ◽

María De Ceano-Vivas ◽

Cristina Calvo ◽

...

Keyword(s):

Abdominal Pain ◽

Acute Appendicitis ◽

Hospital Stay ◽

Incidence Rate ◽

Cumulative Incidence ◽

Complicated Appendicitis ◽

Number Of Patients ◽

Novel Coronavirus ◽

Symptom Progression ◽

Complicated Acute Appendicitis

Abstract Introduction Since home confinement for novel coronavirus disease 2019 (COVID-19) pandemic began, pediatric visits to the emergency department (ED) have decreased, including consultation for abdominal pain. Our aim is to investigate the incidence of complicated acute appendicitis (AA; peritonitis or appendicular mass) during confinement for COVID-19 pandemic and to compare it with the previous 5 years. Materials and Methods A retrospective study was performed in children with AA who underwent surgery between March 9 and April 13 from 2015 to 2020; patients were divided into six groups according to the year of surgery. We analyzed demographic variables, time from onset of symptoms, mean hospital stay, cumulative incidence, and incidence rate of complicated appendicitis. Results A total of 168 patients were included with no differences in the number of patients, gender, and age between groups. Patients in 2020 (COVID-19 group) presented longer symptom progression time (46.8 hours; p = 0.046), higher rate of complicated appendicitis (48.4%; p = 0.004), longer mean hospital stay (4.9 days; p < 0.001), increased cumulative incidence (8.27 cases per 100,000 children per 0.1 years; p < 0.001), and increased incidence rate of complicated appendicitis (83 cases per 100,000 children; p < 0.001) when compared with other groups. Conclusion Delayed ED visit of children with AA during home confinement lead to an increased rate of complicated appendicitis. It is crucial to make parents aware of the importance of early diagnosis and treatment of abdominal pain.

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Study of the association of serum procalcitonin with leukocytosis in predicting complicated acute appendicitis

International Surgery Journal ◽

10.18203/2349-2902.isj20202839 ◽

2020 ◽

Vol 7 (7) ◽

pp. 2300

Author(s):

Thana Ram Patel ◽

Amit Jain ◽

Lakshman Agarwal ◽

Vakta Ram Choudhary ◽

Dinesh Bijarniya

Keyword(s):

Acute Appendicitis ◽

Sensitivity And Specificity ◽

Complicated Appendicitis ◽

Protein Levels ◽

Reactive Protein ◽

Level Measurement ◽

Wbc Count ◽

Operative Findings ◽

Age Range ◽

Complicated Acute Appendicitis

Background: Delay in the diagnosis of complicated appendicitis and its treatment results in an increased rate of postoperative morbidity, mortality and hospital stay. The diagnosis of appendicitis rests on a combination of signs of inflammation such as fever, pain and tenderness; leukocytosis, and elevated C-reactive protein levels, interleukin-6 (IL6) and procalcitonin. Raised level of serum procalcitonin in bacterial infection has been used to further improve the diagnosis of complicated AA.Methods: One-hundred ten patients of appendicitis confirmed by intra-operative findings and final pathologist report, who underwent appendectomy consisting 25 women (22.73%) and 85 men (77.27%) with a mean age of 25 years (age range 15-55 years) were included in this study. Serum procalcitonin value was measured by chemi E411 Cobas method (chemilumiscent immunoassay system) using the B.R.A.H.M.S PCT kit. Serum PCT level >0.5 ng/ml was consider as risk for progression to severe systemic disease.Results: At a 0.5 ng/dl cut-off value of PCT, the sensitivity and specificity of PCT level measurement for acute complicated appendicitis prediction was 90% and 97.14% respectively. Association between WBC count and PCT value shows the sensitivity and specificity in 40 case of acute complicated appendicitis prediction was 86% and 75% respectively.Conclusions: Both the higher PCT values and leukocytosis correlates well with infectious post-operative complications for acute appendicitis and it can help to carry out timely surgical intervention which is highly recommended in complicated appendicitis(correlates PCT >0.5 ng/dl).

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Adenocarcinoma of the appendix mimicking complicated appendicitis in the elderly: A report of two cases

Medicinski pregled ◽

10.2298/mpns1812405c ◽

2018 ◽

Vol 71 (11-12) ◽

pp. 405-408

Author(s):

Mirjana Cuk ◽

Radoslav Gajanin ◽

Slavisa Djuricic ◽

Veljko Maric ◽

Radmil Maric ◽

...

Keyword(s):

Adjuvant Chemotherapy ◽

Acute Appendicitis ◽

Histopathological Examination ◽

Right Hemicolectomy ◽

Complicated Appendicitis ◽

Histopathological Analysis ◽

Low Grade ◽

Recurrent Tumor ◽

Appendiceal Adenocarcinoma ◽

Complicated Acute Appendicitis

Introduction. Primary appendiceal adenocarcinoma is a very rare malignancy which accounts for 0.1% of all appendectomy specimens. In both patients presented in this paper, appendectomy was performed due to suspected acute complicated appendicitis. Case Reports. The first patient, a 77-year-old man, presented with a low grade colonic-type pT3 adenocarcinoma of the appendix, diagnosed by histopathological examination of the resected appendix delivered in a fixative. A month after appendectomy, the patient underwent right hemicolectomy of a tumor at the edge of the resection. Due to a cardiovascular disease, adjuvant chemotherapy was not indicated. The second patient, a 74-year-old female, presented with a low grade mucinous adenocarcinoma of the appendix with subserous infiltration, diagnosed by histopathological analysis of the resected appendix. Eight months after appendectomy, the patient developed a recurrent tumor in the cecal area. After radical surgical excision of the recurrent tumor, the patient received adjuvant chemotherapy. Both patients had a 5-year survival without relapse. Conclusion. Preoperative diagnosis of appendiceal adenocarcinoma is a challenge due to overlapping symptoms of complicated acute appendicitis. Our results suggest that in elderly patients with symptoms of complicated acute appendicitis, appendectomy should be done with intraoperative histopathological frozen section consultation. In advanced stages of adenocarcinoma, right hemicolectomy is a better choice than appendectomy.

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Role of platelet indices as a biomarker for the diagnosis of acute appendicitis and as a predictor of complicated appendicitis: A meta-analysis

Annals of Medicine and Surgery ◽

10.1016/j.amsu.2021.102448 ◽

2021 ◽

pp. 102448

Author(s):

Thawatchai Tullavardhana ◽

Sarat Sanguanlosit ◽

Anuwat Chartkitchareon

Keyword(s):

Acute Appendicitis ◽

Meta Analysis ◽

Complicated Appendicitis ◽

Platelet Indices

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Simple versus complicated appendicitis

International Surgery Journal ◽

10.18203/2349-2902.isj20214481 ◽

2021 ◽

Author(s):

Mahendra Pal Singh

Keyword(s):

Acute Appendicitis ◽

Clinical Experience ◽

Surgical Techniques ◽

Perforated Appendicitis ◽

Complicated Appendicitis ◽

Natural Course ◽

Intraluminal Pressure ◽

Research Papers

Aim of this study is to understand appendicitis in its various presentations. We encounter patients in different stages of the disease. One end of the spectrum is presenting with simple acute appendicitis while other extreme is represented by serious cases of perforated appendicitis. In between cases with various stages of complications could be seen. Simple appendicitis progresses towards complicated one in its natural course. Rise in intraluminal pressure leads to gangrenous perforation. Expertise of the treating surgeon lies in timely detection and intervention. Desired and favorable results are possible to achieve with judicious use of gastrointestinal surgical techniques by the expert. Present study reviews the literature, different research papers and studies available. My own clinical experience in the understanding of appendicitis and its management has enabled me to shape up the article.

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Mathematical modeling for prediction of complicated acute appendicitis in children

Perioperaciina Medicina ◽

10.31636/prmd.v1i1.10 ◽

2018 ◽

Vol 1 (1) ◽

pp. 70-80

Author(s):

V. S. Konoplitsky ◽

V. V. Motygin ◽

A. G. Yakimenko ◽

D. V. Dmytriiev ◽

T. I. Mikhalchuk

Keyword(s):

Mathematical Model ◽

Acute Appendicitis ◽

Postoperative Period ◽

Abdominal Cavity ◽

Control Group ◽

Toxic Substances ◽

Healthy Children ◽

Endogenous Intoxication ◽

Complicated Course ◽

Complicated Acute Appendicitis

Endogenous intoxication, which accompanies the complicated course of acute appendicitis in children, is one of the serious conditions, which are the main cause of complications in the postoperative period. Diverse clinical observations done by clinicians suggest that despite the use of modern technologies in operating equipment, anesthetic support, the number of complications in the postoperative period has no tendency to decrease, and the main cause of lethal outcomes with appendicular peritonitis is lightning development of severe degree of endotoxicosis, which develops as a result of resorbing toxic substances formed of many components, including pathogenic microflora and destruction metabolism. Purpose. Creation of a mathematical model for prediction of complicated acute appendicitis in children using the functions of regression analysis of EXCEL spreadsheet by approximating experimental data. Materials and methods. In the work, there is information about 59 patients with acute appendicitis treated at the clinic of pediatric surgery at the National Pirogov Memorial Medical University. The data on patients were divided into two groups: patients with not complicated course of pathology – 24 patients, and patients with complicated course of acute appendicitis – 35 children. The control group served the data of 37 healthy children. In each of the three groups, the following parameters were studied: gender, age, bed day, duration of the disease, presence of symptoms of peritoneal irritation, the nature of exudate in the abdominal cavity, the number of red blood cells, hemoglobin, leukocytosis, quantitative characteristics of white blood formula, ESR, cellogenic endogenous intoxication: leukocyte index of intoxication and hematological index of intoxication. All the data were determined directly at the time of hospitalization of a patient to the hospital. Results. Discussion. Based on multiple correlation x = f (x1 , x2 ) a two-factor mathematical model of probability of the complicated course of acute appendicitis in children was created. According to the obtained results of the study of the system of three equations with three unknowns, it was established that if the indicator of the form of the disease is y = 2.67 and above, when, in numerical terms, the result falls into the zone of complicated flow of acute appendicitis and completely coincides with data analysis of the three groups of patients. Conclusions. The components that determine the uncomplicated course of acute appendicitis in children, according to the developed two-factor model, include LII and GPI, which exceed the values intoxication of certain intervals studied at the time of hospitalization. The analyzed indices were determined by the degree of severity of the pathological process, duration of disease, virulence of microflora and age of patients against the background of the formed endogenous intoxication syndrome.

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