Delta neutrophil index as an early predictor of acute appendicitis and acute complicated appendicitis in adults

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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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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Assessing perforation of acute appendicitis using the delta neutrophil index reflecting the peripheral immature granulocyte count

Critical Care ◽

10.1186/cc10671 ◽

2012 ◽

Vol 16 (S1) ◽

Author(s):

NG Rhee ◽

S Chung

Keyword(s):

Acute Appendicitis ◽

Granulocyte Count ◽

Immature Granulocyte ◽

Delta Neutrophil Index

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Laparoscopic Appendectomy in Children: Preliminary Study in Pediatric Hospital Albert Royer, Dakar

Gastroenterology Research and Practice ◽

10.1155/2015/878372 ◽

2015 ◽

Vol 2015 ◽

pp. 1-5 ◽

Cited By ~ 1

Author(s):

Mbaye Fall ◽

Doudou Gueye ◽

Ibrahima Bocar Wellé ◽

Faty Balla Lo ◽

Aloise Sagna ◽

...

Keyword(s):

Acute Appendicitis ◽

Complicated Appendicitis ◽

University Hospital ◽

Male Predominance ◽

Average Production ◽

Radiological Data ◽

The Mean ◽

Preliminary Study ◽

The University ◽

Douglas Pouch

Appendiceal pathology’s management has benefited in recent years from the advent of laparoscopic surgery. This study is to make a preliminary assessment of laparoscopic management of acute and complicated appendicitis in children after a few months of practice at the University Hospital Albert Royer, Dakar. This is a retrospective study of 22 cases of patients, all operated on by the same surgeon. The parameters studied were age, sex, clinical data and laboratory features, radiological data, and results of surgical treatment. The mean age of patients was 9.5 years with a male predominance. The series includes 14 cases of acute appendicitis and 8 complicated cases. Appendectomy anterograde is practiced in 81% of cases. Appendectomy was associated with peritoneal wash in 17 patients including 9 cases of acute appendicitis. Drainage of Douglas pouch is performed in 2 patients with complicated appendicitis; the average production was 300 cc of turbid liquids and any complications were not founded. An abscess of Douglas pouch is noted in 2 patients with complicated appendicitis undrained. These Douglas abscesses were treated medically. No conversion of laparotomy was performed in the series. After an average of 8 months no other problems were noted.

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Efficacy of bilirubin values in diagnosing acute appendicitis in patients with normal white blood cell count and predicting complicated appendicitis

Turkish Journal of Trauma and Emergency Surgery ◽

10.14744/tjtes.2020.91441 ◽

2020 ◽

Author(s):

Birkan Birben

Keyword(s):

Acute Appendicitis ◽

Blood Cell ◽

Cell Count ◽

White Blood Cell Count ◽

White Blood Cell ◽

Complicated Appendicitis ◽

Blood Cell Count ◽

Normal White Blood Cell

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Acute appendicitis in children in the context of the new coronavirus infection (COVID-19)

Russian Journal of Pediatric Surgery ◽

10.18821/1560-9510-2021-25-1-25-28 ◽

2021 ◽

Vol 25 (1) ◽

pp. 25-28

Author(s):

V. G. Svarich ◽

I. M. Kagantsov ◽

V. A. Svarich ◽

E. G. Perevozchikov

Keyword(s):

Postoperative Complications ◽

Acute Appendicitis ◽

Medical Care ◽

Surgical Care ◽

Komi Republic ◽

Complicated Appendicitis ◽

Surgical Department ◽

Results Of Treatment ◽

Significant Difference ◽

Coronavirus Infection

Introduction. The first publications about acute appendicitis in the conditions of the new COVID-19 coronavirus infection have appeared. Most authors point to the increased time of seeking medical help in such patients and an increase in the level of postoperative complications.Material and methods. A retrospective study of 192 case histories of patients aged 3 to 17 years with various forms of acute appendicitis who were treated in the surgical Department of the Republican children’s clinical hospital in the period from 2019 to November 2020 was conducted. Children operated on during 2019 before the start of the new coronavirus pandemic were included in the first group (n = 114). Children operated on in 2020 after the development of a new coronavirus pandemic were included in the second group (n = 78).Results. The age of patients in both groups compared did not differ significantly. The course of the disease was within the average accumulated indicators and the terms of hospitalization did not change significantly. According to our observations, the time of admission to the surgical hospital from the time of the disease in the pre-coronavirus period and during it also did not differ significantly, which indicates that the same availability of medical care remains even during the epidemic. Our study also showed that the number of requests for complicated appendicitis in children during the COVID-19 epidemic even decreased, which ultimately led to a decrease in the level of postoperative complications. The study did not establish a significant difference between the main results of treatment of children with acute appendicitis before and during the new COVID-19 coronavirus infection. Only the level of postoperative complications significantly decreased in patients operated during the COVID-19 epidemic, which is associated with a lower admission of children with complicated appendicitis.Conclusion. With the onset of the pandemic, the organization of medical care for the child population with acute pathology in the Komi Republic did not change and did not have any restrictions, which made it possible to maintain the timely provision of surgical care to children with acute appendicitis at the proper level.

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Comparative Study of Laparoscopic Appendectomies With Application of Different Techniques for Closure of the Appendicular Mesoappendix and Stump

Journal of University of Babylon for Pure and Applied Sciences ◽

10.29196/jub.v26i3.630 ◽

2018 ◽

Vol 26 (3) ◽

pp. 196-206

Author(s):

Mohend A.N. Al-Shalah

Keyword(s):

Acute Appendicitis ◽

Comparative Study ◽

Complication Rate ◽

Formation Rate ◽

Complicated Appendicitis ◽

Hospital Charges ◽

Small Vessels ◽

Abdominal Abscesses ◽

Titanium Clips ◽

Duration Of Operation

Background: Laparoscopic appendectomy(LA) has gained a wide safe acceptance and effective method for treatment of acute appendicitis and can be considered as a gold standard. The aim of the study was to evaluate the results of LA performed with the use of different techniques. Method: Prospective randomized comparative study was carried out in a Babylon General Teaching Hospital. Patients diagnosed with acute appendicitis between December 2011 and December 2015 and agreed to do LA were included in this study. In Group A , the mesoappendix and the base of appendix is ligated using titanium clips while in group B ,the mesoappendix was cut with the application of monopolar diathermy very near to the appendix wall and the base of appendix is ligated using vicryle endoloop. In. Primary outcomes were assessed which include mortality ,intra and post-operative complication rate, reinterventions, and converted laparoscopic appendectomies to open .Secondary outcomes were time of hospitalization, duration of operation, wound infection and intra-abdominal abscesses formation rate, hospital charges. Result: A total of 284patients underwent LA. 146 (51.4%) of them ,LA were done by clipping of mesoappendix and base of appendix by titanium clips, while the other 138 (48.6%) of patients LA were done by using monapolar diathermy to the mesoappendix and base of appendix secured by vicryle endoloop. The overall mean age of all patients with appendectomy was (26.42±11.05) years old and (38.7%) of patients were aged between 20-30 years. (52.5%) of patients were males. The overall mean weight, height and BMI for patients with appendectomy were (74.29±12.14) kg, (1.68±0.09) m and (26.68±8.84) kg/m2, respectively. (45.4%) of patients were overweight. The overall mean duration of operation was (31.01±12.48) min and (68.7%) of patients spent less than 30 min operative time, meanwhile, the mean of hospitalization after operation was (22.11± 17.96) hours and (71.8%) of patients stayed less than 20 hours in hospital. Only (8.5%) of patients had complicated appendicitis and complication post-operation, while, (4.9%) of patients had complicated appendectomy. (45.1%) of operations’ cost were 450 US $. There were significant associations between type of appendectomy with duration, complicated operation and price of operation. Conclusion: Laparoscopic appendectomies can be considered a safe treatment of complicated and non complicated appendicitis. Application of monopolar diathermy very near to the wall of appendix to cauterize the small vessels of mesoappendix is useful and safe and considered costly effective and less complication rate than application of Titanium clips.

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