Acute appendicitis is a common surgical emergency worldwide. Recent studies on hematological inflammatory markers concerning acute appendicitis have shown variable results.
The aim of this study was to evaluate pre-operative values of platelet indices such as mean platelet volume (MPV) and platelet distribution width (PDW), and red cell distribution width (RDW) in relation to the diagnosis of acute appendicitis and their efficacy as predictors of appendicular perforation.
A prospective observational study of 190 patients diagnosed with appendicitis and who underwent an appendectomy was undertaken and confirmed histopathologically. Preoperatively, blood samples of white blood cells (WBCs), platelet count, MPV, PDW, and RDW were analyzed using a Sysmex XN1000 analyzer machine.
Of 190 patients, 169 had acute appendicitis, and 21 had perforated appendicitis. The mean age of patients was 28.04 ± 14.2 years. The male-to-female ratio was 1.5:1. The WBC (p<0.05), MPV (p<0.05), and PDW (p<0.05) were found to have higher statistically significant values in acute appendicitis and perforated appendicitis compared to the RDW (p>0.05). However, perforated appendicitis had a higher RDW value compared to acute appendicitis, which can be a predictive factor.
The elevated value of MPV and PDW associated with leukocytosis can be used as supportive evidence for the clinical and radiological diagnosis of acute appendicitis and appendicular perforation. Thus, these values can be used as diagnostic cost-effective inflammatory biomarkers.
The choice of surgical technique to approach the appendicular stump depends mostly on skill and personal preference of the surgeon or on the protocol used in the service, and the influence of this choice in hospitalization time is not evaluated.
To evaluate the relation between surgical technique and postoperative hospitalization time in patients presenting with acute appendicitis.
Retrospective analysis of 180 patients who underwent open appendectomy. These where divided into three groups according to surgical technique: conventional appendectomy (simple ligation of the stump), tobacco pouch suture and Parker-Kerr suture. Data where crossed with hospitalization time (until three days, from four to six days and over seven days).
A hundred and eighty patients with age from 15 to 85 years where included. From these, 95 underwent conventional technique, had an average hospitalization time of 3,9 days and seven had complications (surgical site infection, seroma, suture dehiscence and evisceration). In 67 patients, tobacco pouch suture was chosen and had average hospitalization time of 3,7 days and two complications (infection and seroma). In 18 Parker-Kerr suture was made, with average hospitalization time of 2,6 days, with no complication. Contingency coefficient between the variables hospitalization time and technique was 0,255 and Cramér's V was 0,186.
There was tendency to larger hospitalization time and larger number of complications in conventional appendectomy, whereas in patients where Parker-Kerr suture was performed, hospitalization time was significantly smaller.
: Acute appendicitis is the most common surgical emergency in daily practice, and is approached laparoscopically in many centers. Efforts have been undertaken for the development of minimally invasive techniques that reduce tissue trauma and offer improved cosmetic results, one of such being the single-incision laparoscopic surgery (SILS).
: To present a minimally invasive technique for appendectomy (SILS) undertaken with conventional instruments.
: Eleven patients were treated in the emergency care center presenting abdominal pain in the right iliac fossa that was suggestive of appendicitis. Diagnostic investigation was subsequently conducted, including physical examination, laboratory and imaging exams (CT scan with intravenous contrast or total abdominal ultrasound), and the results were consistent with acute appendicitis. Thus, after consent, these patients underwent SILS appendectomy under general anesthesia with three trocars (two 10 mm and one 5 mm), using conventional and optical laparoscopic tweezers (10 mm, 30º). The base and pedicle of the appendix were ligated with titanium LT 400 clips. The procedure occurred uneventfully. Inclusion criteria were absence of diffuse peritonitis, BMI (body mass index) less than 35 and absence of serious comorbidities or sepsis.
: Seven men and four women were operated with average age of 25.7 years and underwent appendectomy through this technique. Mean procedure duration was of 37.2 min. Regarding surgical findings, three had appendicitis in stage 1, four in stage 2 and four in stage 3. All patients improved well, without surgical complications, and did not require conversion to open surgery or conventional laparoscopy technique.
: Appendectomy conducted through Single Incision Laparoscopic Surgery is a feasible and promising technique that can be performed with conventional laparoscopic instruments.
The aim of this study was to prospectively compare two groups with suspected acute appendicitis, analyzing the number of imaging tests requested, waiting time in the emergency department, until definition of conduct, as well as the sensitivity and specificity of this diagnostic method.
This is a prospective randomized study comparing 55 patients submitted to clinical-radiological diagnosis according to the routine of the service (control group), with another 55 patients submitted to the Appendicitis Inflammatory Response score flowchart (intervention group).
Waiting time for defining the intervention group’s conduct was 1.5 h shorter than the control group (p=0.02). Computed tomography was performed in 42 patients in the control group, compared with 25 in the intervention group (p=0.001). The impact of the flowchart based on the Appendicitis Inflammatory Response score of the cases compared to the control group was the reduction of appendectomies with a normal-appearing appendix from 5 to 1 and an increase in the exclusion of appendicitis diagnoses. The use of the Appendicitis Inflammatory Response score resulted in a diagnostic specificity of 92%, compared to 29% in the control group.
The use of the Appendicitis Inflammatory Response score reduced the waiting time for the diagnosis of acute appendicitis, decreased the number of imaging tests, and increased diagnostic specificity of the disease.
Minilaparoscopy is considered one of the minimally invasive options available for acute appendicitis treatment, although not always employed in less complexity public health services.
Report surgical outcomes of minilaparoscopy use in acute appendicitis treatment.
The study included 21 patients undergoing minilaparoscopic appendectomy with instrumental of 3 mm. The following variables were analyzed: sex, age, body mass index, stage of appendicitis, surgical time, hospital stay, surgical complications, conversion rate to conventional laparoscopy or laparotomy, pain after surgery and aesthetic result.
Twelve men and nine women underwent minilaparoscopic appendectomy. The average age was 27,8 years, the mean BMI was 24,8 kg/m2. The operative time ranged from 33 to 160 min and the average of hospital stay was three days. Among the 21 patients, 20 reported mild pain or no pain in the first postoperative day. The aesthetic result was considered "satisfactory" and "very satisfactory" by 95% of the patients.
The minilaparoscopy is viable technique for treating acute appendicitis with a satisfactory recovery. It combines the benefits of minimally invasive procedures with results similar to conventional techniques.
Appendicitis is a common cause of emergency surgery that in the population undergoing organ transplantation presents a rare incidence due to late diagnosis and treatment.
To report the occurrence of acute appendicitis in a cohort of liver transplant recipients.
Retrospective analysis in a period of 12 years among 925 liver transplants, in witch five cases of acute appendicitis were encountered.
Appendicitis occurred between three and 46 months after liver transplantation. The age ranged between 15 and 58 years. There were three men and two women. The clinical presentations varied, but not discordant from those found in non-transplanted patients. Pain was a symptom found in all patients, in two cases well located in the right iliac fossa (40%). Two patients had symptoms characteristic of peritoneal irritation (40%) and one patient had abdominal distention (20%). All patients were submitted to laparotomies. In 20% there were no complications. In 80% was performed appendectomy complicated by suppuration (40%) or perforation (40%). Superficial infection of the surgical site occurred in two patients, requiring clinical management. The hospital stay ranged from 48 h to 45 days.
Acute appendicitis after liver transplantation is a rare event being associated with a high rate of drilling, due to delays in diagnosis and therapy, and an increase in hospital stay.
When a normal, inflamed or perforated appendix is found as a content in an incarcerated inguinal hernia, it is called the Amyand’s hernia1. The incidence varies from 0.19-1.7% of reported hernia cases2. Appendicitis in Amyand’s hernia is believed to be caused by extra luminal compression and can mimic appendicitis or complicated inguinal hernia. Since both inguinal hernia and acute appendicitis are clinical diagnosis, a preoperative radiological diagnosis is usually not available3. The clinical importance lies in the fact that it can result in various complications due to delayed diagnosis and mortality has been reported in range of 6-15%3,4. The most important determinant of treatment is the presence or absence of appendicitis and periappendiceal abscess5. Use of mesh is traditionally contraindicated in cases of an inflamed or perforated appendix. However, case series have been published with mesh repair, mainly due to the availability of potent antibiotics and biological meshes6,7. We here present our experience of three diverse cases of Amyand’s hernia and review its present literature in brief.
Appendicitis, Hernia, Surgical mesh,
Appendicitis is one of the most common abdominal emergency. Some predictive scoring systems are recommended to decrease the rate of negative appendectomy.
To evaluate sensitivity, specificity, positive predictive value, and negative predictive value of modified Alvarado score in children who underwent appendectomy.
Four hundred children with initial diagnosis of appendicitis were randomly selected from patients who underwent appendectomy. Modified Alvarado score was used for evaluation of the appendicitis, that was confirmed using histology.
Of modified Alvarado score components, anorexia; nausea and vomiting and rebound tenderness were significantly more common in children with positive appendectomy in contrast to patients with negative appendectomy. Sensitivity, specificity, positive predictive value, and negative predictive value for modified Alvarado score were: 91.3%; 38.4%; 87.7%; and 51.2% respectively.
Alvarado score has high sensitivity but low specificity for diagnosis of acute appendicitis in children.
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