Nonsurgical Management of Acute Uncomplicated Appendicitis in Children: the Analysis of Treatment Outcome in Relationship with Antimicrobial Regimens and Adverse Prognostic Factors

SummaryIntroduction.For acute appendicitis - the most frequent condition to perform an urgent abdominal operation in pediatric surgery - surgical appendectomy still remains the gold standard regarding treatment, nevertheless nonsurgical management has become more and more recognized as a treatment method for uncomplicated acute appendicitis (UAA). However there are still many unanswered questions regarding possible factors that could predict the treatment outcome as well as appropriate antimicrobial drug regimens.Aim of the Study.The aim was to investigate if there is a possible association between factors such as C-reactive protein (CRP) level, presence of appendicolith, the diameter of the appendix and treatment outcome; as well as to identify most successfully used antimicrobial drug combinations.Material and methods.A retrospective analysis of hospital cases, admitted to a single reference center during the time period from 2013 to 2015. Patients with clinical signs of acute appendicitis, elevated inflammatory markers and radiological findings suggestive for acute appendicitis were included in the study. Nonsurgical treated patients were divided in two groups based on the treatment outcome - successful or unsuccessful. Analysis of the three factors (CRP level, presence of appendicolith and the diameter of the appendix) and most commonly used antimicrobial drug regimen association with treatment outcome was performed.Results.Overall 384 children medical records with acute appendicitis were registered and non-surgical treatment was initiated in 147/384 (38 %) cases. Successful treatment outcome of nonsurgical management was identified in 114/147 (78 %) cases. Analyzing prognostic adverse factors results presents no statistically significant difference in association with CRP level >25 mg/l (p=0,479), presence of appendicolith (p=0,183) and the diameter of appendix >1 cm (p=0,183) with successful or unsuccessful treatment outcome. The two most commonly used antimicrobial drug combinations were - Ampicillin/Metronidazole for 49 patients and Ampicillin/Gentamicin for 44 patients. No relevance with treatment outcome and used antimicrobial agents was detected (p=0,597).The overall recurrence rate after initial presentation is 15 % (17/114). In 3 cases (3 %) recurrent appendicitis developed one month after discharge and in 14 cases (12 %) up to one year after discharge.Conclusions.Prognostic adverse factors - CRP, presence of appendicolith and diameter of appendix - were not statistically reliable in association with initial non-surgical treatment outcome. The success rate of conservative treatment with narrow spectrum antibiotics was 78 %, which is just as high as in cases treated conservatively with broad-spectrum antibiotics from previous studies. Therefore the question of which factors and antimicrobial drug combinations influence the course of treatment still remains unanswered and further studies are required.

Download Full-text

Appendicitis in puerpeium: Case report

Acta chirurgica iugoslavica ◽

10.2298/aci1104111b ◽

2011 ◽

Vol 58 (4) ◽

pp. 111-112 ◽

Cited By ~ 1

Author(s):

Milica Berisavac ◽

Biljana Kastratovic-Kotlica ◽

V. Tosic ◽

N. Markovic ◽

S. Ljustina ◽

...

Keyword(s):

Case Report ◽

Surgical Treatment ◽

Early Detection ◽

Acute Appendicitis ◽

Abdominal Wall ◽

Clinical Signs ◽

Signs And Symptoms ◽

Laboratory Infection ◽

Infection Parameters ◽

Clinical Signs And Symptoms

Acute appendicitis in puerperium is often diagnosed too late, because clinical signs can be unrelaible. Abdominal wall rigidity is rarely noticed in puerpeium because of weak abdominal wall muscles, laboratory parameters are not enough relaible and atipycal appendix presentation makes difficulties in diagnosis3,4. Knowing clinical signs and symptoms of appendicitis, possible complications and their early detection, make a chance for a good surgical outcome. Measuring of axillar and rectal temperature can take confusion in, and prolong time until surgical treatment. Leucocytosis in puerperium is not valid for diagnosis. We report a case of patient in puerperium with high laboratory infection parameters. Diagnosis of appendicitis is made based on clinical signs and symptoms, that is proved intraoperatively and histologicaly. Appendectomy without perforation carries less risks for mother and fetus.

Download Full-text

The effectiveness and appropriateness of Interval Laparoscopic Appendectomy on adult appendiceal mass, a retrospective cohort

10.21203/rs.2.14168/v1 ◽

2019 ◽

Author(s):

Shiro Fujihata ◽

Hidehiko Kitagami ◽

Yosuke Kitayama ◽

Ayumi Suzuki ◽

Moritsugu Tanaka ◽

...

Keyword(s):

Surgical Treatment ◽

Laparoscopic Appendectomy ◽

Perioperative Complications ◽

Oral Intake ◽

Operation Time ◽

Appendiceal Mass ◽

Uncomplicated Appendicitis ◽

Objective Parameter ◽

Significant Difference ◽

Non Surgical Treatment

Abstract Background: Appendiceal mass sometimes requires extended resection and difficult to treat postoperative complications. Interval appendectomy has been performed mainly in the field of pediatric surgery to avoid them. Recently, there are a few reports on interval laparoscopic appendectomy (ILA). We examined not only the safety and effectiveness of ILA for adult appendiceal mass (AAM), but also the appropriateness of ILA for which cases should be treated non-surgically for ILA or converted to surgical treatment. Methods: Among 956 appendectomies performed between April 2012 and March 2018, there were 49 cases of AAM, of which 34 cases underwent ILA; ILA group. The safety and efficacy of ILA were examined by comparing with 477 cases of adult uncomplicated appendicitis underwent laparoscopic appendectomy (LA); LA group. The appropriateness of ILA was examined by comparing with the remaining 15 cases of AAM; non-ILA group. Results: The ILA group had a longer operation time than the LA group, but the postoperative hospital stay was shorter, and no significant difference were found in the bleeding volume, the days required for oral intake of solid food, and the perioperative complications. Examining the factors for failure of non-surgical treatment or relapse of inflammation during interval period, higher WBC day3 / day0 was found to be an independent risk factor. Conclusion: ILA against AAM was almost as safe and effective as LA for adult uncomplicated appendicitis. WBC day3 / day0 may be effective as an objective parameter for judging the termination of non-surgical treatment for ILA. This determination to convert ineffective non-surgical treatment to surgical treatment earlier may reduce the burden on the patient.

Download Full-text

Laparoscopic Versus Open Appendectomy for the Treatment of Complicated Acute Appendicitis

Advances in Bioscience and Clinical Medicine ◽

10.7575/aiac.abcmed.v.8n.1p.15 ◽

2020 ◽

Vol 8 (1) ◽

pp. 15

Author(s):

Alireza Barband ◽

Amir Mangouri ◽

Changiz Gholipouri ◽

Abasad Gharedaghi

Keyword(s):

Laparoscopic Surgery ◽

Surgical Treatment ◽

Postoperative Pain ◽

Acute Appendicitis ◽

Open Surgery ◽

Surgery Group ◽

Significant Difference ◽

Duration Of Surgery ◽

Duration Of Hospitalization ◽

Complicated Acute Appendicitis

Background and Objective: Acute appendicitis is one of the most common and at the same time lethal if not treated promptly. Failure to treat this medical condition in a timely manner then it can lead to major complications that endanger the patient’s health. In these cases, surgical treatment can be done in an open or laparoscopic method. Despite some limited studies comparing the results of these two therapies, there is still insufficient information in patients with this complicated situation. The aim of this study was to evaluate the results of these two therapies in patients with complicated acute appendicitis. Materials and Methods: In this randomized controlled clinical trial, 52 patients with complicated acute appendicitis in the laparoscopic surgery group and 56 patients in the open surgery group were studied. Primary outcomes in this study were duration of surgery and secondary outcomes including wound infection, intra-abdominal abscess, postoperative pain, miscarriage, hospitalization, and need for re-surgery that were compared between the two groups. Results: Both groups were matched for age (mean 31.0 years in laparoscopic surgery group, 30.5 years in open surgery group, p = 0.81) and gender (28 men in laparoscopic surgery group, 32 men in surgical group, p = 0.73). The mean duration of surgery in the laparoscopic group was significantly longer (mean 66.8 vs. 55.1 min, p <0.001). In contrast, mean duration of hospitalization (85.2 vs 98.6 hours, p <0.001) and mean postoperative pain severity (6.3 vs 7.2, p <0.001) was more significant high in open surgery group. In other cases there was no significant difference between the two groups. Conclusion: Although in surgical treatment of complicated acute appendicitis the duration of laparoscopic surgery is longer than the open method, but the duration of hospitalization and pain intensity in laparoscopic method is significantly reduced.

Download Full-text

Acute Appendicitis in the Elderly: A Literature Review on an Increasingly Frequent Surgical Problem

Geriatrics ◽

10.3390/geriatrics6030093 ◽

2021 ◽

Vol 6 (3) ◽

pp. 93

Author(s):

Sintija Lapsa ◽

Arturs Ozolins ◽

Ilze Strumfa ◽

Janis Gardovskis

Keyword(s):

Surgical Treatment ◽

Literature Review ◽

Acute Appendicitis ◽

Elderly Population ◽

Total Population ◽

Pathological Condition ◽

Clinical Signs ◽

The Elderly ◽

Increased Risk ◽

Overall Health Status

With increased life expectancy and the growing total population of elderly patients, there has been rise in the number of cases of acute appendicitis in elderly people. Although acute appendicitis is not the most typical pathological condition in the elderly, it is not uncommon. Most of these patients require surgical treatment, and as with any acute surgical pathology in advanced age, treatment possibilities are affected by comorbidities, overall health status, and an increased risk of complications. In this literature review we discuss differences in acute appendicitis in the elderly population, with a focus on clinical signs, diagnostics, pathogenesis, treatment, and results.

Download Full-text

Evidence-based treatment of osteoporotic vertebral compression fracture

Journal of Korean Medical Association ◽

10.5124/jkma.2021.64.3.200 ◽

2021 ◽

Vol 64 (3) ◽

pp. 200-207

Author(s):

Subum Lee ◽

Dae-Chul Cho ◽

Kyong-Tae Kim ◽

Young-Seok Lee

Keyword(s):

Surgical Treatment ◽

Outcome Measurement ◽

Treatment Guideline ◽

Treatment Modalities ◽

Vertebral Compression Fractures ◽

Controlled Trials ◽

Evidence Based ◽

Evidence Based Treatment ◽

Significant Difference ◽

Non Surgical Treatment

The prevalence and medical costs of osteoporotic vertebral compression fractures (OVCFs) are on the rise. However, a concrete evidence-based treatment guideline has not yet been established. Despite that numerous randomized controlled trials (RCTs) were performed, the study design and outcome measurement were heterogeneous, and the results were not unified. The purpose of this review is to compare the results of high level-evidence studies to provide a background for evidence-based OVCF treatment. Many reports showed that vertebroplasty has better clinical outcomes than non-surgical treatment for OVCF, but the results of three double-blinded RCTs with the highest level of evidence did not show a significant difference between vertebroplasty and sham procedure. Whether undergoing surgical or non-surgical treatment, OVCF patient management should be started by managing osteoporosis first. Meanwhile, in the results of RCTs related to the comparison of conservative treatment modalities, the benefit of braces and a specific analgesic prescription protocol was also unclear. The presented results of each clinical trial were generally inconsistent and may not be appropriate in all situations. Any decision by clinicians to apply this evidence must be made considering individual patients and available resources. At present, controversy remains about the best treatment modality for OVCF. Large, multicenter, placebo/sham-controlled trials are needed to address this gap and establish strong evidence-based guidelines.

Download Full-text

Methylprednisolone pulse therapy for patients with moderately severe Graves' orbitopathy: a prospective, randomized, placebo-controlled study

Acta Endocrinologica ◽

10.1530/eje-07-0558 ◽

2008 ◽

Vol 158 (2) ◽

pp. 229-237 ◽

Cited By ~ 44

Author(s):

Rob J van Geest ◽

Inna V Sasim ◽

Hans P F Koppeschaar ◽

Rachel Kalmann ◽

Simone N Stravers ◽

...

Keyword(s):

Treatment Outcome ◽

Severe Disease ◽

Clinical Signs ◽

Pulse Therapy ◽

Controlled Study ◽

Clinical Activity ◽

Number Of Patients ◽

Significant Difference ◽

Graves Orbitopathy ◽

Minor Criteria

ObjectiveTo assess whether methylprednisolone (MP) pulse therapy is efficacious in the treatment of moderately severe Graves' orbitopathy (GO).DesignProspective, placebo (PL)-controlled, double-blind, randomized study.MethodsFifteen previously untreated patients with active, moderately severe GO participated in the study; 6 patients received MP and 9 patients a PL. Moderately severe disease was defined using the NOSPECS classification of clinical signs of GO . Activity was measured with the clinical activity score (CAS). A dose of 500 mg MP or only solvent was administered intravenously, over three consecutive days, in four cycles at 4 weekly intervals (6 g of MP in total). Qualitatively, a successful treatment outcome was defined as an improvement in one major and/or two minor criteria in the worst eye at week 48. The major criteria were: improvement in diplopia grade; improvement in eye movement; a decrease in CAS of three points. The minor criteria were: decrease of eyelid retraction; decrease of proptosis; improvement in grade of soft tissue swelling; a decrease in CAS of two points.ResultsThe qualitative treatment outcome was successful at the end of the trial in five out of six (83%) patients receiving MP and in one out of nine (11%) patients given the PL (relative risk=7.5; (95% confidence interval 1.1–49.3), P=0.005). The treatment was well tolerated.ConclusionsIn spite of the small number of patients, a significant difference in outcome was observed between MP- and PL-treated patients. We conclude that MP pulse therapy appears to be an effective treatment for active, moderately severe GO.

Download Full-text

The role of bacteriophages in the complex treatment of peritonitis of appendicular origin (experimental study)

Vestnik of Experimental and Clinical Surgery ◽

10.18499/2070-478x-2017-10-4-265-268 ◽

2017 ◽

Vol 10 (4) ◽

pp. 265-268

Author(s):

Evgeny Mikhailovich Mokhov ◽

Artem Mikhailovich Morozov ◽

Victor Alekseevich Kadykov ◽

Elshad Magomedovich Askerov ◽

Nina Evgenievna Serova

Keyword(s):

Surgical Treatment ◽

Postoperative Complications ◽

Acute Appendicitis ◽

Intraperitoneal Injection ◽

Abdominal Cavity ◽

Experimental Studies ◽

Morphological Data ◽

White Rats ◽

Single Intraperitoneal Injection ◽

Significant Difference

Relevance: with the management of laparoscopic methods of surgical treatment of acute appendicitis, the problem of the occurrence of early postoperative complications has not changed at present, which makes it necessary to carry out preventive measures. Objective: to study the possibility of improving the results of surgical treatment of peritonitis, the most frequent complication of acute appendicitis, by reducing the number of postoperative complications of infectious genesis. Methods: Studies were performed on 47 non-linear white rats weighing 200-250 grams by modelling peritonitis using the biological model as an example, followed by antibiotic therapy and combination therapy using bacteriophages. To model peritonitis, the infection of the abdominal cavity with the E. coli strain 25922 was used. The laboratory animals were divided into 3 groups: the first group was control group, the second group received treatment in the form of a single intraperitoneal injection of Cefipime, the third group received treatment as a single intraperitoneal injection of the Sextapage. Results: the evaluation of the methods was carried out on the basis of the study of the clinical picture of the course of peritonitis in experimental animals, the data of pathomorphological and histological examination of the sectional peritoneum. As a result of experimental studies, there was no significant difference in the methods of perioperative prevention of complications of acute appendicitis, which makes it possible to perform monotherapy with bacteriophages. Phages in comparison with antibiotics have no less therapeutic efficacy. Conclusions: Thus, our experimental studies revealed completely satisfactory results of monotherapy of experimental peritonitis with a bacteriophage. According to the morphological data, the inflammatory process in the abdominal cavity is stopped by the phage fast enough and there is a tendency for a faster fading of the inflammation than in the treatment with antibiotics.

Download Full-text

The Dynamics of Inflammatory Markers in Patients with Suspected Acute Appendicitis

Medicina ◽

10.3390/medicina57121384 ◽

2021 ◽

Vol 57 (12) ◽

pp. 1384

Author(s):

Ąžuolas Algimantas Kaminskas ◽

Raminta Lukšaitė-Lukštė ◽

Eugenijus Jasiūnas ◽

Artūras Samuilis ◽

Vytautas Augustinavičius ◽

...

Keyword(s):

Acute Appendicitis ◽

Diagnostic Accuracy ◽

Inflammatory Mediators ◽

Inflammatory Markers ◽

Laboratory Tests ◽

Clinical Signs ◽

Signs And Symptoms ◽

Significant Difference ◽

Wbc Count ◽

Suspected Acute Appendicitis

Background: Laboratory tests of inflammatory mediators are routinely used in the diagnosis of acute appendicitis (AA). The aim of this study was to evaluate the differences of dynamics of inflammatory markers of the blood in patients with suspected acute appendicitis between complicated AA (CAA), non-complicated AA (NAA), and when AA was excluded (No-AA). Methods: This was a retrospective analysis of prospectively collected data of patients presented to the Emergency Department (ER) of a tertiary hospital center during a three-year period. All patients suspected of acute appendicitis were prospectively registered from 1 January 2016 to 31 December 2018. The dynamics of inflammatory markers of the blood between different types of AA (No-AA, NAA or CAA) during different periods of time are presented. Results: A total of 453 patients were included in the study, with 297 patients in the No-AA group, 99 in the NAA group, and 57 in the CAA group. White blood cell (WBC) count in the No-AA decreased with time, with a statistically significant difference between the <8 h and 25–72 h group. The neutrophils (NEU) percentage decreased in the No-AA group and was statistically significantly different between the <8 h and 25–72 h and <8 h and >72 h groups. C-reactive protein (CRP) increased significantly in the No-AA group throughout all time intervals, and from the first 24 h to the 25–72 h in the NAA and CAA groups. There was a statistically significant difference between the WBC count between No-AA, NAA, and No-AA and CAA groups during the first 24 and 24–48 h. There was a statistically significant difference between NEU percentage and LYMP percentage and in the NEU/LYMP ratio between No-AA and CAA groups through all time periods. CRP was significantly higher in the first 24 h in the CAA than in the No-AA group, and in the 24–48 h in the CAA group than in the No-AA and NAA groups. The linear logistic regression model, involving inflammatory mediators and clinical characteristics, showed mediocre diagnostic accuracy for diagnosing AA with an AUC of 0.737 (0.671–0.802). Conclusions: Increasing concentrations of inflammatory markers are more characteristic in CAA patients than in No-AA during the first 48 h after onset of the disease. A combination of laboratory tests with clinical signs and symptoms has a mediocre diagnostic accuracy in suspecting AA.

Download Full-text

Hyperbilirubinemia as a diagnostic marker for acute appendicitis

International Surgery Journal ◽

10.18203/2349-2902.isj20181977 ◽

2018 ◽

Vol 5 (6) ◽

pp. 2091

Author(s):

Sagar Ramesh Ambre ◽

Shahaji Chavan

Keyword(s):

Acute Appendicitis ◽

Clinical Diagnosis ◽

Diagnostic Marker ◽

Iliac Fossa ◽

Clinical Signs ◽

Research Centre ◽

College Hospital ◽

Alvarado Score ◽

Delay In Diagnosis ◽

Significant Difference

Background: Appendicitis is one of the commonest cause of abdominal pain requiring emergency surgery. Different clinical signs and symptoms always mimic the diagnosis of acute appendicitis with number of causes leading to pain in right iliac fossa, especially in females. Accurate diagnosis can be aided by additional tests. A delay in diagnosis can lead to appendiceal perforation with increased morbidity, and an appendectomy as soon as the condition is suspected, may increase the number of unnecessary appendicectomies. Objective of present study was to evaluate the role of hyperbilirubinemia as a diagnostic marker for Acute Appendicitis.Methods: This is a prospective study of 100 patients carried out at Dr. D.Y. Patil Medical College, Hospital and Research Centre, Pimpri, Pune from May 2015 to September 2017. Patients presenting to surgical OPD with pain in Right iliac fossa will be evaluated. Those with a clinical diagnosis of acute appendicitis will be included in the study.Results: Acute appendicitis is one of the most common emergencies and appendicectomy is one of the most frequently done abdominal operations. Clinical diagnosis using time tested clinical signs is effective in diagnosing appendicitis. However, bilirubin supports diagnosis and hence avoids chances of error in diagnosis. The investigation Bilirubin alone is not sufficient to accurately diagnose acute appendicitis, however the clinical findings, ALVARADO SCORE when combined can predict appendicitis. There is significant difference in total bilirubin in acute and probable cases of appendicitis but it can be used to differentiate both of them. In present study Mean bilirubin for acute appendicitis was 1.23mg/dl and probable cases of appendicitis was 0.84mg/dl, with SD for acute appendicitis was 0.598 and probable cases of appendicitis was 0.486. In our study bilirubin provide the highest diagnostic accuracy for acute appendicitis case. Normal inflammatory markers cannot exclude appendicitis, which remains a clinical diagnosis. The presence of history of pain and or signs of peritoneal inflammation which help you in diagnosing acute appendicitis.Conclusions: Hyperbilirubinemia can be a diagnostic marker for acute appendicitis.

Download Full-text

COMPARACIÓN DE LOS RESULTADOS CLÍNICOS EN PACIENTES CON HIPERPLASIA PROSTÁTICA BENIGNA CON TRATAMIENTO INICIAL FARMACOLÓGICO, NO FARMACOLÓGICO Y QUIRÚRGICO, ATENDIDOS EN EL HOSPITAL PABLO ARTURO SUÁREZ DE ENERO 2014 A DICIEMBRE 2016.

Revista Medica Vozandes ◽

10.48018/rmv311.s1 ◽

2020 ◽

Vol 31 (1) ◽

Author(s):

Esteban Noroña Vásconez ◽

Patricia Páez Vargas

Keyword(s):

Surgical Treatment ◽

Benign Prostatic Hyperplasia ◽

Pharmacological Treatment ◽

Clinical Signs ◽

Clinical Results ◽

Scientific Data ◽

Prostatic Hyperplasia ◽

Urinary Symptoms ◽

Post Intervention ◽

Significant Difference

Background: Currently there are few scientific data comparing the three therapeutic modalities of Benign Prostatic Hyperplasia to determine the best clinical outcome, considering that it is a pathology whose incidence increases as population life expectancy arise. Objective: To compare the clinical results between the initial pharmacological, non-pharmacological and surgical treatment, based on clinical signs of prostatism in patients with benign prostatic hyperplasia during the period between January 2014 and December 2016. Study Design: Retrospective Cohort Study. Methods: 399 patients were divided according to the modality of treatment received: non-pharmacological, pharmacological and surgical. The decrease of the symptoms was compared with the first post-treatment consultation by using a matrix of evaluation of urinary symptoms elaborated by the authors, based on SPSS International Score; this tool stratified the patients by the severity of the symptomatology. SPSS ® software was used. Results: Within the non-pharmacological treatment, there was a mean difference of 1.67 (95% CI 0.49 - 2.85, p <0.05); for the pharmacological it was 0.21 (95% CI 0.92 - 1.34, p = 0.713) and for the surgical was 8.23 (95% CI 7.19 - 9.27, p <0.05). Significant differences were found between the three groups during the pretreatment phase, after stratifying them according to the degree of severity. Post-intervention, the clinical results of each treatment were compared, finding that in patients with mild symptoms there were no significant differences (p = 0.087), not so for patients with moderate and severe symptoms where a statistically significant difference was found. Conclusion: In patients with urinary symptoms classified as moderate and severe within this sample, surgical treatment decreased urinary symptomatology in greater proportion compared to pharmacological and non-pharmacological treatment.

Download Full-text