scholarly journals Antibiotics in acute appendicitis. When and how? A general review

2019 ◽  
Vol 6 (1) ◽  
pp. 30-33
Author(s):  
L. Alecu ◽  
C. Niţipir ◽  
Iulian Slavu ◽  
V. Braga ◽  
D. Mihăilă ◽  
...  
Keyword(s):  
Acute Appendicitis ◽  
Antibiotic Treatment ◽  
Complication Rate ◽  
Acquired Resistance ◽  
Perforated Appendicitis ◽  
Interval Appendectomy ◽  
Bacterial Proliferation ◽  
Long Period ◽  
Clinical Surveillance ◽  
Relapse Rates

Introduction: An increasing interest exits towards the use of antibiotics in the treatment of uncomplicated acute appendicitis.Discussion: For a long period of time, surgery was the only treatment for acute appendicitis. Due to recent research in the etiology of acute appendicitis which seems to be driven by intraluminal bacterial proliferation, new data suggests that for non-perforated appendicitis confirmed with the help of CT, antibiotics may play a central role in the treatment. As relapse rates amount in some cases to only 5% after antibiotic treament, a discussion is required regarding the risks of interval appendectomy and its use. The debate regarding the optimal antibiotic course is on-going as some surgeons advocate for amoxicillin/clavulanic while others, due to acquired resistance recommend Ertapenem.Conclusion:  Selective antibiotic treatment for selected forms of acute appendicitis, uncomplicated without perforation is safe and has a relatively low complication rate. However, certain mentions must be made:  surgery must not be delayed if failure of antibiotics exists as it can lead to higher rates of peritonitis. Close clinical surveillance is of utmost importance

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.

Can Acute Appendicitis be Treated by Antibiotics Alone?

2007 ◽  
Vol 73 (11) ◽  
pp. 1161-1165 ◽  
Author(s):  
Katherine Liu ◽  
Sadie Ahanchi ◽  
Mark Pisaneschi ◽  
Irene Lin ◽  
Robert Walter
Keyword(s):  
Length Of Stay ◽  
Acute Appendicitis ◽  
Antibiotic Treatment ◽  
Alternative Treatment ◽  
Complication Rate ◽  
Standard Of Care ◽  
Group I ◽  
Recurrent Appendicitis ◽  
Group Ii

Emergency appendectomy at presentation has been the standard of care for acute appendicitis. We examined the use of antibiotics as an alternative treatment. From September 2002 to August 2003, 170 consecutive patients diagnosed with acute appendicitis without abscess were reviewed retrospectively. Patients were divided into two groups: Group I (n = 151) underwent emergency appendectomy and Group II (n = 19) received antibiotics alone. The mode of treatment was at the attending surgeon's discretion. The overall complication rate was eight per cent for Group I and 10 per cent for Group II patients ( P = 0.22). Group II patients suffered no complications during antibiotic treatment, and any complications that did occur developed after subsequent appendectomy. One Group II patient had recurrent appendicitis (5%). The length of stay was 2.61 ± 0.21 days for Group I and 2.95 ± 0.38 days for Group II patients ( P = 0.57). Patients with acute appendicitis may be treated safely with antibiotics alone without emergency appendectomy.

scholarly journals Delayed Detection of a Carcinoid Tumor after Conservative Therapy for Appendicitis in a 13-Year-Old Boy and a 17-Year-Old Girl

2021 ◽  
Vol 09 (01) ◽  
pp. e61-e64
Author(s):  
Leonie Annina Korsch ◽  
Thomas Michael Boemers ◽  
Peter Zimmermann ◽  
Martin Stenzel ◽  
Wera Wendenburg
Keyword(s):  
Acute Appendicitis ◽  
Antibiotic Treatment ◽  
Carcinoid Tumor ◽  
Conservative Therapy ◽  
Pediatric Population ◽  
Severe Disease ◽  
Perforated Appendicitis ◽  
Uncomplicated Appendicitis ◽  
Safe Approach

AbstractAcute appendicitis is common in children and adolescents. Recently, conservative antibiotic treatment is regarded to be a safe approach to treat uncomplicated appendicitis. It is already established as initial treatment in cases of perforated appendicitis with perityphlitic abscess, commonly followed by interval appendectomy. We report on a 13-year-old boy with uncomplicated appendicitis and a 17-year-old girl with complicated, perforated appendicitis and perityphlitic abscess in whom initially successful antibiotic treatment led to a delay in detection of a carcinoid tumor (neuroendocrine tumor, NET) of the appendix. NET of the appendix, with an incidence of 0.03 to 0.8% in the pediatric population undergoing appendectomy for acute appendicitis, are usually incidental findings after appendectomy with no secure method for detection prior to surgery. Raising concern about this rare but severe disease, we recommend information of patients and their parents about the potential risk of belated diagnosis before opting for conservative their treatment of acute appendicitis. Furthermore, patients successfully treated conservatively require a close follow-up by ultrasound. In presence of any conspicuous finding, especially on imaging, appendectomy should be considered.

Interval Appendectomy for Perforated Appendicitis in Children

1998 ◽  
Vol 8 (4) ◽  
pp. 209-214 ◽  
Author(s):  
ANTHONY J. BUFO ◽  
RASIK S. SHAH ◽  
MARY H. LI ◽  
NANCY A. CYR ◽  
ROBERT S. HOLLABAUGH ◽  
...  
Keyword(s):  
Perforated Appendicitis ◽  
Interval Appendectomy

Appendicitis: a rare adverse event in colonoscopy

2021 ◽  
Vol 14 (7) ◽  
pp. e242523
Author(s):  
Samer Al-Dury ◽  
Mohammad Khalil ◽  
Riadh Sadik ◽  
Per Hedenström
Keyword(s):  
Emergency Department ◽  
Adverse Event ◽  
Abdominal Pain ◽  
Acute Appendicitis ◽  
Physical Examination ◽  
De Novo ◽  
Perforated Appendicitis ◽  
Lower Quadrant ◽  
The Right ◽  
Right Lower Quadrant

We present a case of a 41-year-old woman who visited the emergency department (ED) with acute abdomen. She was diagnosed with perforated appendicitis and abscess formation on CT. She was treated conservatively with antibiotics and discharged. On control CT 3 months later, the appendix had healed, but signs of thickening of the terminal ileum were noticed and colonoscopy was performed, which was uneventful and showed no signs of inflammation. Twelve hours later, she developed pain in the right lower quadrant, followed by fever, and visited the ED. Physical examination and blood work showed signs consistent with acute appendicitis, and appendectomy was performed laparoscopically 6 hours later. The patient recovered remarkably shortly afterwards. Whether colonoscopy resulted in de novo appendicitis or exacerbated an already existing inflammation remains unknown. However, endoscopists should be aware of this rare, yet serious complication and consider it in the workup of post-colonoscopy abdominal pain.

scholarly journals The diagnostic value of white cell count, C-reactive protein and bilirubin in acute appendicitis and its complications

2013 ◽  
Vol 95 (3) ◽  
pp. 215-221 ◽  
Author(s):  
I G Panagiotopoulou ◽  
D Parashar ◽  
R Lin ◽  
S Antonowicz ◽  
AD Wells ◽  
...  
Keyword(s):  
Acute Appendicitis ◽  
Diagnostic Accuracy ◽  
Cell Count ◽  
Inflammatory Markers ◽  
White Cell Count ◽  
Perforated Appendicitis ◽  
Diagnostic Value ◽  
White Cell ◽  
C Reactive Protein ◽  
Reactive Protein

Introduction Inflammatory markers such as white cell count (WCC) and C-reactive protein (CRP) and, more recently, bilirubin have been used as adjuncts in the diagnosis of appendicitis. The aim of this study was to determine the diagnostic accuracy of the above markers in acute and perforated appendicitis as well as their value in excluding the condition. Methods A retrospective analysis of 1,169 appendicectomies was performed. Patients were grouped according to histological examination of appendicectomy specimens (normal appendix = NA, acute appendicitis = AA, perforated appendicitis = PA) and preoperative laboratory test results were correlated. Receiver operating characteristic (ROC) curve area analysis (area under the curve [AUC]) was performed to examine diagnostic accuracy. Results ROC analysis of all laboratory variables showed that no independent variable was diagnostic for AA. Good diagnostic accuracy was seen for AA when all variables were combined (WCC/CRP/bilirubin combined AUC: 0.8173). In PA, the median CRP level was significantly higher than that of AA (158mg/l vs 30mg, p<0.0001). CRP also showed the highest sensitivity (100%) and negative predictive value (100%) for PA. CRP had the highest diagnostic accuracy in PA (AUC: 0.9322) and this was increased when it was combined with WCC (AUC: 0.9388). Bilirubin added no diagnostic value in PA. Normal levels of WCC, CRP and bilirubin could not rule out appendicitis. Conclusions CRP provides the highest diagnostic accuracy for PA. Bilirubin did not provide any discriminatory value for AA and its complications. Normal inflammatory markers cannot exclude appendicitis, which remains a clinical diagnosis.

scholarly journals DIFFERENCES IN LEUKOCYTE RATE BETWEEN ACUTE NONPERFORATED AND PERFORATED APPENDICITIS IN HOSPITALISED PATIENTS BANDAR LAMPUNG-INDONESIA

2019 ◽  
Vol 2 (1) ◽  
pp. 25-31
Author(s):  
Festy Ladyani ◽  
Nur Fitria Dewi
Keyword(s):  
Acute Appendicitis ◽  
Public Hospital ◽  
Leucocyte Count ◽  
Univariate Analysis ◽  
Perforated Appendicitis ◽  
Sampling Technique ◽  
Bivariate Analysis ◽  
P Value ◽  
Cross Sectional ◽  
Hospitalised Patients

Background: Acute appendicitis is one of the most common acute abdominal pain. A late check up and diagnosis could bring harms which is turning into perforated appendicitis. Leukocyte count is a laboratory collation that is generous and quick to diagnose the acute apendicitis and perforated appendicitis, however there’s no certain limit of the leukocytes count to recognize whether it is acute apendicitis or perforated appendicitis.Purpose: This research was to find out the comparison of leucocyte count average between acute appendicitis and perforation appendicitis in Dr. H. Abdul Moeleok public hospital of Lampung province in 2014-2016.Methods: An analytic research with cross sectional approach. Population was 382 patients with appendicitis in Dr. Hi. Abdul Moeloek public hospital. Samples were taken using total sampling technique with 196 respondent samples for acute appendicitis and 196 respondent samples for perforation appendicitis. Data were analyzed by using univariate analysis with percentage and bivariate analysis with t-test.Results: the average of leucocyte count of acute appendicitis patients was 10,907 with minimum and maximum leucocyte count of 5,000 and 18,500 respectively. The average of leucocyte count of perforation appendicitis patients was 22,789 with minimum and maximum leucocyte count of 16,500 and 31,000 respectively. There were differences of leucocyte counts between acute appendicitis patients and perforation appendicitis patients with p-value < 0.05.Conclusion: there were significant differences of leucocyte count averages between acute appendicitis and perforation appendicitis.

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 A study to assess the role of raised total leucocyte count in diagnosis of acute appendicitis

2020 ◽  
Vol 7 (10) ◽  
pp. 1541
Author(s):  
Rajesh Kumar ◽  
Renu Chauhan
Keyword(s):  
Acute Appendicitis ◽  
Predictive Value ◽  
Leucocyte Count ◽  
Histopathological Examination ◽  
Perforated Appendicitis ◽  
Cross Sectional Study ◽  
Total Leucocyte Count ◽  
Cross Sectional ◽  
Gandhi Medical College ◽  
Low Sensitivity

Introduction: Total Leucocyte Count (TLC) is an easily available and commonly performed investigation and studies have reported various degrees of leucocytosis in patients with acute appendicitis. This study was performed with the aim to assess the diagnostic validity of raised TLC count in acute appendicitis.Methods: This was a cross sectional study conducted from 2013 to 2015, in the Department of General Surgery, Indira Gandhi Medical College, Shimla. A clinical diagnosis of acute appendicitis was made based on detailed history taking, clinical examination, and laboratory investigations including TLC count. 50 patients with acute appendicitis were enrolled in the study by convenience sampling, after taking a written, informed consent. Appendicectomy specimen were sent for histopathological examination (HPE).Results: The mean age of the patients was 26.48 ± 12.28 years. 29 (58%) patients were male, and 21 (42%) were female. The negative appendicectomy rate in the present study was 14%. 7 (14%) were normal appendices, 31 (62%) inflamed appendices, 4 (8%) perforated appendices, and 8 (16%) gangrenous appendices as per HPE report. In our study, there were 12 (24%) cases of complicated appendicitis i.e., 8 (16%) cases of gangrenous appendicitis and 4 (8%) cases of perforated appendicitis). TLC had a sensitivity 76.74%, specificity 51.14%, positive predictive value 91.66%, and negative predictive value 28.57%.Conclusion: In our study, TLC was found to have low sensitivity and specificity for acute appendicitis. Hence, used alone, TLC may not be diagnostic of acute appendicitis. However, used in conjunction with other laboratory parameters, it will lead to improvement of diagnostic accuracy.

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