The Histopathology of the Appendix in Children at Interval Appendectomy

Whilst most surgeons agree that conservative treatment of appendiceal abscess in children is an adequate treatment, the need for subsequent interval appendectomy is still controversial. We analyzed the histopathology in interval appendectomy in search of signs of inflammation. All patients admitted between 2010 and 2017 with appendiceal abscess and scheduled for interval appendectomy were reviewed. The specimens were evaluated for grade of inflammation, type and distribution of cellular infiltrate, presence of necrosis or hemorrhage and infiltrate in the serosa. Forty-two patients had appendiceal abscess and were treated conservatively. Seven underwent emergent appendectomy. Thirty-three out of 35 patients underwent elective interval appendectomy. Thirty-two specimens were revised. Carcinoid tumor or other malignant lesions were not found. All of them presented some amount of inflammation, grade 1 to 2 in 53%, grade 3 to 4 in 47%. Twenty-five percent of the specimens had signs of necrosis accompanied by hemorrhage and in more than the half (53%) the infiltrate extended to the serosa. Conclusions: Although the appendix was mostly found not macroscopically inflamed intraoperatively, histology confirmed a certain grade of inflammation even months after the conservative treatment. No correlation was found between histopathologic findings and lapse of time between abscess treatment and interval appendectomy.

Delay in Appendicectomy due to Pre-operative Imaging Results in Increased Complication Rate

Objectives: To determine the frequency of delay in case of suspected acute appendicitis and to determine the frequency of complications in patients of acute appendicitis having delay secondary to pre-operative imaging. Study Design: Descriptive study Place and Duration of Study: Department of General Surgery Unit-2, University of Lahore Teaching Hospital, Lahore 1st January 2020 to 31st March 2021. Methodology: Three hundred and eighty five patients, between 18-40 years of age of both genders presenting with clinically appendicitis were included. All the patients were operated under general anesthesia by a consultant surgeon having minimum of 5 years of experience. Results: The mean age was 28.746±5.25 years. Majority of the patients were between 26-30 years (42.6%). Body mass index of the patients were ˃25kg/m2 in 57.7%. Delay was seen in 155 (40.03%) cases, peri-appendiceal abscess was seen in 10 (2.6%) and peritonitis was seen in 13. Complications due to delay was pri-appendiceal abscess 8 and peritonitis 13 with p value ˂0.05. Conclusion: Delay in the appendectomy due to pre operative imaging has shown significant impact on complications rate and therefore suggests that delaying appendectomy is unsafe. Keywords: Appendectomy, Peri-appendiceal abscess, Peritonitis

725. Influence of An Emerging Pathogen, Streptococcus anginosus, on Clinical Outcomes in Pediatric Appendiceal Abscess

Background Escherichia Coli is the most common primary pathogen in appendiceal abscess, but an increasing number involve Streptococcus anginosus (SA) as the primary isolate. Ten years of data from a regional medical center was reviewed to track changes in the microbiology and outcomes of this condition. We believe that SA is emerging as a significant pathogen in appendiceal abscess in children and it is associated with increased morbidity compared to more commonly encountered pathogens. Methods A medical records search was done (IRB#5194) for patients below age 18 from 1/2008 to 12/2017 with acute appendicitis with local/generalized peritonitis or peritoneal abscess. There were 557 records retrieved, of which 201 had appendiceal abscess. The records were further divided based on the type of operation and timing of abscess development. There were 104 laparoscopic, 34 open, 4 drain alone, 53 interval management with a drain, and 6 interval without a drain. The focus of the study is laparoscopic and open post operative abscess. 56 of the laparoscopic cases developed a postoperative abscess of whom 45 had culture and sensitivity data. 25 of the open cases developed a postoperative abscess of whom 24 had culture and sensitivity data. Results Of the 45 postoperative abscesses following laparoscopic procedure, the most common isolate was E. coli (34) followed by SA (13). Of the 24 postoperative abscesses following open procedure, the most common isolate was also E. Coli (17) followed by SA (6). Patients are divided into those who had any culture of SA (SA group), vs those who did not (non-SA group). For laparoscopic cases there was no difference between additional procedures needed. However for open procedures, the SA group had an average of 2.33 additional procedures needed compared to the 0.94 additional procedures for the non-SA group (p=0.024). Major adverse outcomes included one death from sepsis, abdominal compartment syndrome, and one patient needing bilateral salpingectomy, all in the SA group. Conclusion SA has emerged as an important and virulent pathogen in complex appendicitis in pediatric patients. It is sensitive to commonly used antibiotics, but is associated with increased risks of reoperation, additional drainage and adverse outcome for the sicker patients who require an open procedure. Disclosures All Authors: No reported disclosures

Complete Genome Sequence of Clostridium innocuum Strain ATCC 14501

ABSTRACT We report the complete genome sequence of Clostridium innocuum ATCC 14501, which was isolated in 1962 from an appendiceal abscess. At that time, the isolated strain was designated C. innocuum, given its suspected lack of virulence, but recent reports suggest that C. innocuum is an emerging pathogen.