Alterations of the preoperative coagulation profile in patients with acute appendicitis

2011 ◽  
Vol 49 (8) ◽  
Author(s):  
Jianxin Li ◽  
Yan Liu ◽  
Weihua Yin ◽  
Chuanzhou Zhang ◽  
Jinhe Huang ◽  
...  
Keyword(s):  
Acute Appendicitis ◽  
Elective Surgery ◽  
Characteristic Curve ◽  
Perforated Appendicitis ◽  
Complicated Appendicitis ◽  
Thrombin Time ◽  
Limited Data ◽  
Coagulation Activity ◽  
Control Subjects ◽  
Coagulation Testing

AbstractAcute appendicitis (AA) is usually associated with a systemic inflammatory response that often leads to activation of coagulation. However, limited data about coagulation changes in AA are available.Results of preoperative coagulation testing in 702 patients with confirmed AA and 697 patients undergoing minor elective surgery (control) during the same period were analyzed retrospectively. Coagulation activity of factors VII, IX (FVII:C, FIX:C) and the concentration of plasma endotoxin from 40 patients with AA and 15 control subjects were measured.Compared with control subjects, prothrombin time (PT), fibrinogen (Fib) and endotoxin increased (all p<0.01), FVII:C decreased (p<0.05), and thrombin time shortened (p<0.01) significantly in patients with AA, which showed trends with increasing severity of disease. Areas under the receiver operating characteristic curve of Fib for discriminating complicated appendicitis or acute perforated appendicitis from enrolled patients were larger than those for leukocyte parameters. The concentration of endotoxin correlated negatively with FVII:C (r=−0.860, p<0.001), positively with PT (0.713, <0.001), and FVII:C negatively with PT (−0.729, <0.001) in individuals that were evaluated. The change in activated partial thromboplastin time and difference in FIX:C among patients with various pathological types of appendicitis were not significant.Endotoxin-induced activation of the extrinsic coagulation pathway was present in patients with AA. Fib may be useful as a potential indicator for excluding complicated appendicitis.

scholarly journals Increased incidence of complicated acute appendicitis after the first COVID-19 pandemic peak: Have patients a different attitude towards COVID-hospitals?

2021 ◽  
Vol 108 (Supplement_4) ◽  
Author(s):  
S Passoni ◽  
M Giuliani ◽  
M Arigoni
Keyword(s):  
Acute Appendicitis ◽  
Elective Surgery ◽  
Histopathological Examination ◽  
World Health Organisation ◽  
Complicated Appendicitis ◽  
World Health ◽  
Original Structure ◽  
Group A ◽  
Wbc Count ◽  
Complicated Acute 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.

scholarly journals Simple versus complicated appendicitis

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.

scholarly journals Milyen hatása van a COVID–19-járványnak a gyermekkori akut appendicitisekre?

2021 ◽  
Vol 162 (16) ◽  
pp. 608-610
Author(s):  
Balázs Fadgyas ◽  
Gábor István Garai ◽  
Zoltán Ringwald
Keyword(s):  
Statistical Analysis ◽  
Acute Appendicitis ◽  
Antibiotic Treatment ◽  
Laparoscopic Appendectomy ◽  
Perforated Appendicitis ◽  
Complicated Appendicitis ◽  
Histological Findings ◽  
Exact Test ◽  
Fisher's Exact Test ◽  
Fisher’S Exact Test

Összefoglaló. Bevezetés: A COVID–19-pandémia miatt a gyermekkori appendicitisek kezelésében számos változás történt (laparoszkópia helyett nyílt műtét, antibiotikumkezelés). Világszerte emelkedett a szövődményes appendicitisek aránya. Célkitűzés: Munkánk során a COVID–19-járványnak a gyermekkori akut appendicitisekre kifejtett hatását szerettük volna vizsgálni: lett-e több perforált eset? Módszerek: A 2012 és 2020 között akut vakbélgyulladás miatt operált gyermekeket vizsgáltuk, külön, havi bontásban a 2020-as eseteket. A szövettani diagnózis alapján perforált és nem perforált appendicitis csoportokat alkottunk. A 2020-ban operált betegek COVID–19-statusát is rögzítettük. Statisztikai analízisre a khi2-próbát (’chi2 test for trend’) és a Fisher-féle egzakt tesztet alkalmaztuk. Eredmények: A vizsgált időszakban 1343 appendectomia történt, többségében nem perforált akut appendicitis miatt (1166/1343). 2015-től kezdődően a perforált esetek aránya szignifikáns emelkedést mutat (p = 0,0002). Az igazoltan COVID–19-pozitív betegek között magasabb volt a perforáltak aránya (5/8), mint az igazoltan negatív betegek között (15/92) (p = 0,0075). Megbeszélés: A nemzetközi trendeknek megfelelően 2020-ban osztályunkon is magasabb volt a perforált appendicitisek aránya, mint a korábbi években. Ez az emelkedés 2015-től tart, a pandémiával nem mutat szoros összefüggést. A perforált appendicitisek COVID–19-pozitív betegek között észlelt magas arányának okát nem ismerjük. Következtetés: További vizsgálat indokolt annak feltárására, hogy mi okozza a perforált appendicitisek COVID–19-pozitív betegek között észlelt magas, illetve 2015 óta emelkedő rátáját. Orv Hetil. 2021; 162(16): 608–610. Summary. Introduction: As a result of the COVID-19 pandemic, the management of paediatric appendicitis has changed (open instead of laparoscopic appendectomy, antibiotic treatment). The number of complicated appendicitis cases increased worldwide. Objective: Our aim was to study the effect of the COVID-19 pandemic on paediatric acute appendicitis: has there been more perforated cases? Methods: Children operated because of acute appendicitis between 2012 and 2020 were studied. Cases from the year 2020 were analysed monthly. Patients were divided into perforated and non-perforated appendicitis groups according to their histological findings. COVID-19 status of patients in 2020 was studied. Chi2 test for trend and Fisher’s exact test were used for statistical analysis. Results: In the study period, 1343 appendectomies were performed. The majority of our cases were non-perforated (1166/1343). The rate of perforated appendicitis cases has been increasing from 2015 (p = 0.0002). The number of perforated cases was higher in COVID-19 positive patients (5/8) then in negative ones (15/92) (p = 0.0075). Discussion: In line with the international trend, more perforated appendicitis cases were treated in our departement in 2020. However, this increase started in 2015, and there is no correlation with the COVID-19 pandemic. The cause of the increased number of perforated cases in COVID-19 positive appendicitis patients is unknown. Conclusion: The causes of the high proportion of perforated cases in COVID-19 positive patients and the rising rate of perforated appendicitis cases since 2015 need further studies. Orv Hetil. 2021; 162(16): 608–610.

scholarly journals Scoring System for Differentiation of Complicated Appendicitis in Pediatric Patients: Appendicitis Scoring System in Children

2021 ◽  
Vol 8 ◽  
pp. 2333794X2110222
Author(s):  
Yujin Lee ◽  
Hyunjin Cho ◽  
Geumhee Gwak ◽  
Byungnoe Bae ◽  
Keunho Yang
Keyword(s):  
Body Temperature ◽  
Acute Appendicitis ◽  
Scoring System ◽  
Multiple Logistic Regression Analysis ◽  
Laboratory Data ◽  
Area Under The Curve ◽  
Perforated Appendicitis ◽  
Scoring Systems ◽  
Complicated Appendicitis ◽  
Free Fluid

Although several scoring systems have been used to differentiate simple acute appendicitis from perforated appendicitis, no particular system has been widely accepted. Therefore, this study aimed to investigate preoperative factors associated with complicated appendicitis and to develop a scoring system that distinguishes complicated appendicitis in children aged <10 years. Patients aged <10 years who underwent surgical treatment for acute appendicitis between 2011 and 2019 were included in this study, after excluding those with insufficient medical records, with other diseases that affect the length of hospitalization, or without formal reports of abdominal computed tomography (CT) or ultrasonography (US). Complicated appendicitis was defined as hospitalization for ≥5 days postoperatively or readmission within 30 days postoperatively. Patient characteristics, symptoms, physical examination, laboratory data, and radiographic results were collected to determine predictors of complicated appendicitis. The mean age of 279 patients was 7.3 years. Among them, 57 patients had complicated appendicitis. A scoring system was developed based on the following 5 independent risk factors derived from multiple logistic regression analysis: body temperature, anorexia, diarrhea, C-reactive protein (CRP) level, and presence of periappendiceal free fluid on CT or US. The scoring system resulted in an area under the curve of .898 ( P < .001). For patients aged <10 years, a new model that includes objective factors, such as body temperature, CRP levels, and radiography results, might help predict complicated appendicitis and determine treatment plans.

scholarly journals Evaluation of role of hyperbilirubinemia as a new diagnostic marker of complicated appendicitis

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Sabyasachi Bakshi ◽  
Nilay Mandal
Keyword(s):  
Acute Appendicitis ◽  
Likelihood Ratio ◽  
Bilirubin Level ◽  
Predictive Value ◽  
Total Bilirubin ◽  
Serum Bilirubin ◽  
Perforated Appendicitis ◽  
Total Bilirubin Level ◽  
Complicated Appendicitis

Abstract Background In appendicitis, elevated intra-luminal pressure and ischemic necrosis of mucosa causes tissue gangrene or perforation. This leads to cytotoxin facilitated progressive bacterial invasion or translocation into the hepatic parenchyma through portal system. This phenomenon interferes with the bilirubin excretion into the bile canaliculi. In the present study, establishment of a possible role of hyperbilirubinemia as a marker of gangrenous/perforated appendicitis has been studied. Methods After matching the inclusion and exclusion criteria, all cases of clinically diagnosed acute appendicitis were taken for this prospective, single center, observational study. Per-operative diagnosis was confirmed by histopathological examination. Results Out of 110 subjects of acute appendicitis 41 subjects (37.27%) had hyperbilirubinemia. Out of 35 subjects diagnosed as complicated appendicitis 32 subjects (91.42%) had raised total bilirubin levels, while the remaining 03 (8.58%) had normal levels. Among 75 subjects diagnosed as acute simple appendicitis 09 subjects (12%) had raised total bilirubin level, while the remaining 66 subjects (88%) had normal levels. It was Mixed Type of Hyperbilirubinemia in gangrenous/perforated appendicitis. The sensitivity of Total serum bilirubin in predicting complicated appendicitis was found 91.43% (76.942% to 98.196%), where as the specificity of this test was 88.00% (78.439% to 94.363%). positive predictive value and negative predictive value were 78.03% and 95.65% respectively. Positive likelihood ratio and negative likelihood ratio were found to be 7.619 and 0.097 respectively taking prevalence of complicated appendicitis be 31.80%. Receiver Operating Characteristic curve was obtained which shows optimal criterion at Total Bilirubin Level 1.06 mg/dl where sensitivity was 91.43% and specificity was 97.33% at 95% confidence interval with 31.8% disease prevalence. Conclusions This is to conclude that Serum bilirubin level estimation, which is a simple, cheap and easily available laboratory test, can be added to the routine investigations in clinically suspected cases of acute appendicitis for early diagnosis of complications. Trial registration Registered with Clinical Trials Registry-India (ICMR-NIMS) with Registration number CTRI/2019/05/018879 Dated 01/05/2019. This was a prospective trial. Trial URL: http://ctri.nic.in/Clinicaltrials/pdf_generate.php?trialid=33113&EncHid=99780.32960&modid=1&compid=19%27,%2733113det%27.

scholarly journals Frequency and outcome of complicated appendicitis in toddlers and pre-schoolers

2020 ◽  
Vol 1 (1) ◽  
Author(s):  
Naseem Khan ◽  
Muhammad Ayub Khan ◽  
Jehangir Khan ◽  
Sajjad Ali ◽  
Imran Khattak ◽  
...  
Keyword(s):  
Acute Appendicitis ◽  
Pediatric Population ◽  
Perforated Appendicitis ◽  
Cross Sectional Study ◽  
Complicated Appendicitis ◽  
Cross Sectional ◽  
Generalized Peritonitis ◽  
Operative Findings ◽  
Study Participants ◽  
Emergency Abdominal Surgery

Background: Acute appendicitis is a frequent indication of emergency abdominal surgery in the pediatric population. In younger children, especially toddlers, and preschoolers, the presentation is comparatively late resulting in complicated appendicitis. This study was done to determine the frequency and outcome of complicated appendicitis in toddlers and preschoolers. Methods: This is a cross-sectional study done at the Department of Pediatric Surgery, Lady Reading Hospital Peshawar, during August 2018 and February 2019. The medical records of 144 toddlers and preschoolers who presented with acute appendicitis were reviewed for demography, clinical presentation, operative findings, and outcome. Frequency and types of complicated appendicitis were recorded. Results: The mean age of study participants was 3 years (±2.84), including 46(32%) toddlers and 98(68%) preschoolers. Overall 62% of patients were male while 38% of patients were female. Complicated appendicitis was documented in 75% of patients. The common types of complicated appendicitis were perforation of the appendix with a localized abscess in 68 patients, gangrenous appendicitis in 4 patients, generalized peritonitis in 24 patients, and mass formation in 12 patients. All patients did well after surgery, except one who succumbed to complications of leukemia. Conclusion: In our study, a great deal (75%) of toddlers and preschoolers had complicated appendicitis especially perforated appendicitis with localized peritonitis.

scholarly journals Evaluation of Role of Hyperbilirubinemia as a New Diagnostic Marker of Complicated Appendicitis.

2020 ◽  
Author(s):  
Sabyasachi Bakshi ◽  
Nilay Mandal
Keyword(s):  
Acute Appendicitis ◽  
Likelihood Ratio ◽  
Bilirubin Level ◽  
Predictive Value ◽  
Total Bilirubin ◽  
Serum Bilirubin ◽  
Perforated Appendicitis ◽  
Total Bilirubin Level ◽  
Complicated Appendicitis

Abstract BACKGROUND: In appendicitis, elevated intra-luminal pressure and ischemic necrosis of mucosa causes tissue gangrene or perforation. This leads to cytotoxin facilitated progressive bacterial invasion or translocation into the hepatic parenchyma through portal system. This phenomenon interferes with the bilirubin excretion into the bile canaliculi.In the present study, establishment of a possible role of hyperbilirubinemia as a marker of gangrenous/perforated appendicitis has been studied. METHODS: After matching the inclusion and exclusion criteria, all cases of clinically diagnosed acute appendicitis were taken for this prospective, single center, observational study. Per-operative diagnosis was confirmed by histopathological examination. RESULTS: Out of 110 subjects with acute appendicitis, 41 subjects (37.27%) had hyperbilirubinemia. Out of 35 subjects, diagnosed as complicated appendicitis, 32 subjects (91.42%) had raised total bilirubin levels, while the remaining 03(8.58%) had normal levels .Among 75 subjects diagnosed as acute simple appendicitis 09 subjects (12%) had raised total bilirubin level, while the remaining 66 subjects (88%) had normal levels .It was MIXED TYPE OF HYPERBILIRUBINEMIA in gangrenous/perforated appendicitis. The SENSITIVITY of Total serum bilirubin in predicting complicated appendicitis was found 91.43% (76.942% to 98.196%), where as the SPECIFICITY of this test was 88.00% (78.439% to 94.363%). POSITIVE PREDICTIVE VALUE and NEGATIVE PREDICTIVE VALUE were 78.03% and 95.65% respectively. POSITIVE LIKELIHOOD RATIO and NEGATIVE LIKELIHOOD RATIO were found to be 7.619 and 0.097 respectively taking PREVALENCE of Complicated appendicitis be 31.80%. ROC (Receiver Operating Characteristic) curve was obtained which shows OPTIMAL CRITERION at Total Bilirubin Level 1.06 mg/dl where sensitivity was 91.43% and specificity was 97.33% at 95% confidence interval with 31.8% disease prevalence. CONCLUSIONS: Serum Bilirubin level estimation, which is a simple, cheap and easily available laboratory test, can be added to the routine investigations in clinically suspected cases of acute appendicitis for early diagnosis of complications. Trial Registration:Trial URL: http://ctri.nic.in/Clinicaltrials/rmaindet.php?trialid=33113&EncHid=2976.35990&modid=1&compid=19

scholarly journals Evaluation of Role of Hyperbilirubinemia as a New Diagnostic Marker of Complicated Appendicitis.

2020 ◽  
Author(s):  
Sabyasachi Bakshi ◽  
Nilay Mandal
Keyword(s):  
Acute Appendicitis ◽  
Bilirubin Level ◽  
Predictive Value ◽  
Total Bilirubin ◽  
Serum Bilirubin ◽  
Perforated Appendicitis ◽  
Total Bilirubin Level ◽  
Complicated Appendicitis ◽  
Direct Invasion

Abstract BACKGROUND: Hyperbilirubinemia has also been found in infective diseases involving organs other than liver. The bacteremia/endotoxemia resulting in impaired hepatocyte function and bile secretion along with increased acute phase reactants contribute to the pathogenesis. In appendicitis, elevated intra-luminal pressure and ischemic necrosis of mucosa causes tissue gangrene/perforation. This is accompanied by bacterial cytotoxin facilitated progressive bacterial invasion. This elevated load of bacteria causes direct invasion or translocation into the portal system. Direct invasion of bacteria into the hepatic parenchyma interferes with the bilirubin excretion into the bile canaliculi biochemically rather than by any obstructive pathway. In the present study, establishment of a possible role of hyperbilirubinemia as a marker of gangrenous/perforated appendicitis has been studied. METHODS: After matching the inclusion and exclusion criteria, all cases of clinically diagnosed acute appendicitis were taken for this prospective, single center, observational study. Per-operative diagnosis was confirmed by histopathological examination. RESULTS: Out of 110 patients of acute appendicitis 41 patients (37.27%) had hyperbilirubinemia. Out of 35 patients diagnosed as complicated appendicitis 32 patients (91.42%) had raised total bilirubin levels, while the remaining 03(8.58%) had normal levels .Among 75 patients diagnosed as acute simple appendicitis 09 patients (12%) had raised total bilirubin level, while the remaining 66 patients (88%) had normal levels .It was MIXED TYPE OF HYPERBILIRUBINEMIA in gangrenous/perforated appendicitis. The SENSITIVITY of Total serum bilirubin in predicting complicated appendicitis was found 91.43% (76.942% to 98.196%), where as the SPECIFICITY of this test was 88.00% (78.439% to 94.363%). POSITIVE PREDICTIVE VALUE and NEGATIVE PREDICTIVE VALUE were 78.03% and 95.65% respectively. POSITIVE LIKELIHOOD RATIO and NEGATIVE LIKELIHOOD RATIO were found to be 7.619 and 0.097 respectively taking PREVALENCE of Complicated appendicitis be 31.80%. ROC (Receiver Operating Characteristic) curve was obtained which shows OPTIMAL CRITERION at Total Bilirubin Level 1.06 mg/dl where sensitivity was 91.43% and specificity was 97.33% at 95% confidence interval with 31.8% disease prevalence. CONCLUSIONS: Serum Bilirubin level estimation, which is a simple, cheap and easily available laboratory test, can be added to the routine investigations in clinically suspected cases of acute appendicitis for early diagnosis of complications. Trial Registration:Trial URL: http://ctri.nic.in/Clinicaltrials/rmaindet.php?trialid=33113&EncHid=2976.35990&modid=1&compid=19

Should All Complicated Appendicitis be Treated the Same? the Answer is No

2019 ◽  
Vol 85 (10) ◽  
pp. 1179-1183
Author(s):  
Victoria Wang ◽  
Diego Kriger ◽  
Elias Fanous ◽  
Alfred Lee ◽  
Bishoy Zakhary ◽  
...  
Keyword(s):  
Adverse Events ◽  
Acute Appendicitis ◽  
Conservative Management ◽  
Perforated Appendicitis ◽  
Late Presentation ◽  
Complicated Appendicitis ◽  
Fecal Fistula ◽  
Delayed Presentation ◽  
Radiologic Findings ◽  
Uncomplicated Appendicitis

Delayed presentation of acute appendicitis is associated with increased complications. We hypothesized that the outcomes of appendectomy in delayed presentations of acute appendicitis (>72 hours of pain) were dependent on radiologic findings rather than late presentation. We reviewed records from 2009 to 2015 and analyzed delayed presentations of acute appendicitis. We divided patients into three groups based on specific CT findings: uncomplicated appendicitis (UA), phlegmon or abscess (PA), and other perforated appendicitis (PERF, signs of perforation without abscess or phlegmon). One hundred thirty-eight patients were included in this study (58 in the UA, 67 in the PA, and 13 in the PERF groups). Overall, 78 (57%) patients underwent early appendectomy (EA) and 60 (43%) underwent initial conservative management. The incidence of adverse events was lower in EA than that in initial conservative management (17% vs 42%, P = 0.005). EA in the UA group was associated with shorter hospitalization (3.2 vs 5.6 days, P < 0.001) and less adverse events (6% vs 29%, P < 0.05). Severe adverse events (two colectomies and one fecal fistula) were observed in the PA group. In conclusion, in these late presentations of appendicitis, complicated appendicitis was common. EA was safe in selected patients, however, and associated with decreased adverse events.

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

2021 ◽  
Author(s):  
Cristina García-Amador ◽  
Vladimir Arteaga Peralta ◽  
Roberto de la Plaza Llamas ◽  
Miguel Torralba ◽  
Anibal Medina Velasco ◽  
...  
Keyword(s):  
Acute Appendicitis ◽  
Complicated Appendicitis ◽  
Complicated Acute Appendicitis
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