BACKGROUND Acute appendicitis with an appendicolith is one of the most common abdominal emergencies in elderly patients and is more likely to progress to gangrene and perforation.AIM To analyze the clinical data of el...BACKGROUND Acute appendicitis with an appendicolith is one of the most common abdominal emergencies in elderly patients and is more likely to progress to gangrene and perforation.AIM To analyze the clinical data of elderly patients undergoing emergency appende-ctomy for acute appendicitis,aiming to improve treatment strategies.METHODS The clinical data of 122 patients over 80 years old who underwent emergency appendectomy for acute appendicitis at the Department of Emergency Surgery of Zhongshan Hospital,Fudan University from January 2016 to March 2023 were retrospectively analyzed.The patients were divided into two groups based on the presence of an appendicolith or not,and clinicopathological and surgery-related features were compared between the two groups.RESULTS The duration of abdominal pain in all 122 patients ranged from 5 to 168 h.All patients underwent emergency appendectomy:6 had an open appendectomy,101 had a laparoscopic appendectomy,and 15 required conversion from laparoscopic to open surgery,resulting in a conversion rate of 12.9%(15/116).The patients were divided into two groups:Appendicolith group(n=46)and non-appendi-colith group(n=76).Comparisons of clinicopathological features revealed that patients with appendicoliths were more likely to develop appendiceal gangrene(84.8%vs 64.5%,P=0.010)and perforation(67.4%vs 48.7%,P=0.044),and had a lower surgical conversion rate(2.2%vs 19.7%,P=0.013).The median length of hospital stay was 5.0 d for both groups and there was no significant difference between them.All patients were successfully dis-charged.CONCLUSION Around 40%of patients over 80 years old with acute appendicitis have an appendicolith,increasing their risk of developing appendiceal gangrene and perforation,and therefore should receive timely surgical treatment.展开更多
Right iliac fossa pain remains a challenge for clinicians, since it requires considering several differential diagnoses. Acute appendicitis continues to be one of the most important diagnoses to confirm or to rule out...Right iliac fossa pain remains a challenge for clinicians, since it requires considering several differential diagnoses. Acute appendicitis continues to be one of the most important diagnoses to confirm or to rule out in acute abdominal pain, due to the associated morbidity and mortality. Currently, imaging studies contribute to increase diagnostic certainty, but sometimes reveal unexpected findings, which may further complicate the diagnosis and therapeutic decisions. We present the case of an unusual image finding in the right iliac fossa, a calcification suggestive of gallstone ileus, in the context of an acute abdomen with an unusual transoperative finding, whose definitive diagnosis by pathology, was also rare.展开更多
Purpose: To determine whether the presence and/or location of an appendicolith can predict failure of initial non-operative management in children with ruptured appendicitis. Methods: A retrospective chart review of p...Purpose: To determine whether the presence and/or location of an appendicolith can predict failure of initial non-operative management in children with ruptured appendicitis. Methods: A retrospective chart review of pediatric patients presenting with ruptured appendicitis was performed. Patients in whom the intent to treat was with initial non-operative management and interval appendectomy (IA) were selected (n = 117). One patient was excluded due to the presence of both intraluminal and extraluminal appendicoliths. Children who failed initial non-operative management were assigned to the “failure” group (n = 22). Children that improved and underwent elective IA were assigned to the “success” group (n = 94). Age, gender, duration of symptoms, presence of an appendicolith, appendicolith location (intraluminal/extraluminal), presence of a drainable abscess, and complications were reviewed. Results: There was an overall 18.8% failure rate for IA. Patients with an appendicolith had a 41.7% failure rate, and patients without an appendicolith had a 13% failure rate (p = 0.003). Patients with intraluminal or extraluminal appendicoliths each had a 41.7% failure rate. The presence or absence of a drainable in-tra-abdominal abscess did not affect the failure rate. Children in the failure group presented to the hospital earlier (6.57 ± 2.59 vs. 10.02 ± 7.21 days;p = 0.030). Conclusions: The presence of an appendicolith increases the likelihood of failure of initial non-operative management of ruptured appendicitis in children;however, the location of the appendicolith is not a predictor of failure.展开更多
BACKGROUND Although antibiotic therapy has become the primary treatment for acute unco-mplicated appendicitis,the management of acute complicated appendicitis nece-ssitates careful consideration of various treatment o...BACKGROUND Although antibiotic therapy has become the primary treatment for acute unco-mplicated appendicitis,the management of acute complicated appendicitis nece-ssitates careful consideration of various treatment options.AIM To analyze the clinical data of patients who underwent emergency appendectomy for acute complicated appendicitis with peri-appendiceal abscess or phlegmon,identify factors influencing the postoperative length of hospital stay(LOS),and improve treatment strategies.METHODS The clinical data of acute complicated appendicitis patients with peri-appendiceal abscess or phlegmon who underwent emergency appendectomy at The Depart-ment of Emergency Surgery,Zhongshan Hospital,Fudan University from January 2016 to March 2023 were retrospectively analyzed.RESULTS A total of 234 patients were included in our study.The duration of symptoms and the presence of an appendicolith were significantly correlated with the occurrence of peri-appendiceal abscess in patients with acute complicated appendicitis(P<0.001 and P=0.015,respectively).Patients with symptoms lasting longer than 72 h had a significantly longer postoperative LOS compared to those with symptoms lasting 72 h or less[hazard ratio(HR),1.208;95%CI:1.107-1.319;P<0.001].Additionally,patients with peri-appendiceal abscesses had a significantly longer postoperative LOS compared to those with phlegmon(HR,1.217;95%CI:1.095-1.352;P<0.001).The patients with peri-appendiceal abscesses were divided into two groups based on the median size of the abscess:Those with abscesses smaller than 5.0 cm(n=69)and those with abscesses 5.0 cm or larger(n=82).Patients with peri-appendiceal abscesses measuring 5.0 cm or larger had a significantly longer postoperative LOS than those with abscesses smaller than 5.0 cm(P=0.038).CONCLUSION The duration of symptoms and the presence of an appendicolith are significant risk factors for the formation of peri-appendiceal abscesses in patients with acute complicated appendicitis.Patients with peri-appendiceal abscesses experience a significantly longer postoperative LOS compared to those with peri-appendiceal phlegmon.展开更多
BACKGROUND Acute appendicitis is one of the most common emergency abdominal disease,and recent studies have evaluated conservative treatment using antibiotics for uncomplicated appendicitis.Although the efficacy of co...BACKGROUND Acute appendicitis is one of the most common emergency abdominal disease,and recent studies have evaluated conservative treatment using antibiotics for uncomplicated appendicitis.Although the efficacy of conservative treatment for uncomplicated appendicitis is known,its efficacy for complicated appendicitis remains unknown,so are risk factors for the conservative treatment of appendi-citis.In our institution,conservative treatment has long been the first choice for most appendicitis cases,except for perforation.Therefore,this novel study inves-tigated the outcomes of conservative treatment for uncomplicated and compli-cated acute appendicitis and the risk factors associated with conservative treat-ment.treatment.The significant and independent predictors of resistance to conservative treatment were body temperature≥37.3℃,appendicolith and Douglas sinus fluid visible on computed tomography(CT).The rate of resistance to conservative treatment was 66.7%(6/9)for patients with the above three factors,22.9%(8/35)for patients with two factors(appendicolith and body temperature≥37.3℃),16.7%(2/12)for patients with two factors(Douglas sinus fluid and appendicolith)and 11.1%(1/9)for patients with two factors(Douglas sinus fluid and body temperature≥37.3℃).CONCLUSION A temperature≥37.3℃,appendicolith and Douglas sinus fluid on CT might be clinical risk factors of resistance to conservative treatment for acute appendicitis.展开更多
Background Appendicolith can cause appendiceal obstruction and acute appendicitis.Its high prevalence may be related to the high perforation rate in pediatric appendicitis.This study assessed the characteristics of ap...Background Appendicolith can cause appendiceal obstruction and acute appendicitis.Its high prevalence may be related to the high perforation rate in pediatric appendicitis.This study assessed the characteristics of appendicolith and its clinical significance in pediatric appendicitis.Methods A retrospective study was performed among children and adolescents younger than 17 years who were preopera-tively diagnosed with appendicitis in the pediatric emergency department(ED).A total of 269 patients with a mean age of 9.98±3.37 years were enrolled.Clinical features and contrast-enhanced computed tomography findings were analyzed.Results Among the 269 patients,147(54.6%)had appendicoliths,with a mean maximal diameter of 5.21±2.34 mm.Com-pared to the no appendicolith group,the appendicolith group demonstrated more prolonged abdominal pain(≥48 hours)before the ED visit(23.1%vs.11.5%;P=0.013),clinical features of severe appendicitis(presence of fever,vomiting,posi-tive urine ketone,and increased C-reactive protein),and higher rate of perforation(43.5%vs.9.8%;P<0.001).Multivariate risk factor analysis for perforated appendicitis in the appendicolith group revealed that maximal diameter of 5 mm or more in the appendicolith(adjusted odds ratio[aOR]2.919;95%CI 1.325-6.428,P=0.008)and proximal collapse adjacent to the appendicolith(aOR 2.943;95%CI 1.344-6.443,P=0.007)were significant.Conclusions Pediatric appendicitis with appendicolith often presents with prolonged abdominal pain and severe clinical conditions with a high risk of perforation.展开更多
Introduction: The appendix is identified as blind ending tubular structure arising from caecum and has variable intraluminal contents and position. Acute appendicitis is one of the common indications for emergency ima...Introduction: The appendix is identified as blind ending tubular structure arising from caecum and has variable intraluminal contents and position. Acute appendicitis is one of the common indications for emergency imaging studies. Aim: To describe the importance of appendix hyperattenuation and densities. Material and Methods: Contrast enhanced computed tomography images of abdomen from 120 patients with surgically/pathological proven acute appendicitis, were examined retrospectively. The images were reviewed in axial, coronal and sagittal reformations for assessing the intraluminal contents (hyperdensity and appendicolith), maximum transverse diameter and single wall thickness of appendix, periappendiceal fat stranding and other parameters related to acute appendicitis. In addition, reviewing 100 pre- and post-contrast CT scans of other abdominal conditions as a control group for documenting hyperdense appendix, appendicolith and other signs of appendicitis. Results: The hyperdense appendix sign was found in 5 patients in our study, not found in any patient of the control group (P value = 0.039, is statistically), appendicolith was found in 25% in patients with acute appendicitis, in 3% in control group (statistically significant, p < 0.0001). Conclusion: The hyperdense appendix and appendicolith have strong association with acute appendicitis in the appropriate clinical setting.展开更多
基金Supported by the National Natural Science Foundation of China,No.82373417Natural Science Foundation of Shanghai,No.23ZR1409900Clinical Research Fund of Zhongshan Hospital,Fudan University,No.ZSLCYJ202343.
文摘BACKGROUND Acute appendicitis with an appendicolith is one of the most common abdominal emergencies in elderly patients and is more likely to progress to gangrene and perforation.AIM To analyze the clinical data of elderly patients undergoing emergency appende-ctomy for acute appendicitis,aiming to improve treatment strategies.METHODS The clinical data of 122 patients over 80 years old who underwent emergency appendectomy for acute appendicitis at the Department of Emergency Surgery of Zhongshan Hospital,Fudan University from January 2016 to March 2023 were retrospectively analyzed.The patients were divided into two groups based on the presence of an appendicolith or not,and clinicopathological and surgery-related features were compared between the two groups.RESULTS The duration of abdominal pain in all 122 patients ranged from 5 to 168 h.All patients underwent emergency appendectomy:6 had an open appendectomy,101 had a laparoscopic appendectomy,and 15 required conversion from laparoscopic to open surgery,resulting in a conversion rate of 12.9%(15/116).The patients were divided into two groups:Appendicolith group(n=46)and non-appendi-colith group(n=76).Comparisons of clinicopathological features revealed that patients with appendicoliths were more likely to develop appendiceal gangrene(84.8%vs 64.5%,P=0.010)and perforation(67.4%vs 48.7%,P=0.044),and had a lower surgical conversion rate(2.2%vs 19.7%,P=0.013).The median length of hospital stay was 5.0 d for both groups and there was no significant difference between them.All patients were successfully dis-charged.CONCLUSION Around 40%of patients over 80 years old with acute appendicitis have an appendicolith,increasing their risk of developing appendiceal gangrene and perforation,and therefore should receive timely surgical treatment.
文摘Right iliac fossa pain remains a challenge for clinicians, since it requires considering several differential diagnoses. Acute appendicitis continues to be one of the most important diagnoses to confirm or to rule out in acute abdominal pain, due to the associated morbidity and mortality. Currently, imaging studies contribute to increase diagnostic certainty, but sometimes reveal unexpected findings, which may further complicate the diagnosis and therapeutic decisions. We present the case of an unusual image finding in the right iliac fossa, a calcification suggestive of gallstone ileus, in the context of an acute abdomen with an unusual transoperative finding, whose definitive diagnosis by pathology, was also rare.
文摘Purpose: To determine whether the presence and/or location of an appendicolith can predict failure of initial non-operative management in children with ruptured appendicitis. Methods: A retrospective chart review of pediatric patients presenting with ruptured appendicitis was performed. Patients in whom the intent to treat was with initial non-operative management and interval appendectomy (IA) were selected (n = 117). One patient was excluded due to the presence of both intraluminal and extraluminal appendicoliths. Children who failed initial non-operative management were assigned to the “failure” group (n = 22). Children that improved and underwent elective IA were assigned to the “success” group (n = 94). Age, gender, duration of symptoms, presence of an appendicolith, appendicolith location (intraluminal/extraluminal), presence of a drainable abscess, and complications were reviewed. Results: There was an overall 18.8% failure rate for IA. Patients with an appendicolith had a 41.7% failure rate, and patients without an appendicolith had a 13% failure rate (p = 0.003). Patients with intraluminal or extraluminal appendicoliths each had a 41.7% failure rate. The presence or absence of a drainable in-tra-abdominal abscess did not affect the failure rate. Children in the failure group presented to the hospital earlier (6.57 ± 2.59 vs. 10.02 ± 7.21 days;p = 0.030). Conclusions: The presence of an appendicolith increases the likelihood of failure of initial non-operative management of ruptured appendicitis in children;however, the location of the appendicolith is not a predictor of failure.
基金Supported by The National Natural Science Foundation of China,No.82373417The Natural Science Foundation of Shanghai,China,No.23ZR1409900The Clinical Research Fund of Zhongshan Hospital,Fudan University,China,No.ZSLCYJ202343.
文摘BACKGROUND Although antibiotic therapy has become the primary treatment for acute unco-mplicated appendicitis,the management of acute complicated appendicitis nece-ssitates careful consideration of various treatment options.AIM To analyze the clinical data of patients who underwent emergency appendectomy for acute complicated appendicitis with peri-appendiceal abscess or phlegmon,identify factors influencing the postoperative length of hospital stay(LOS),and improve treatment strategies.METHODS The clinical data of acute complicated appendicitis patients with peri-appendiceal abscess or phlegmon who underwent emergency appendectomy at The Depart-ment of Emergency Surgery,Zhongshan Hospital,Fudan University from January 2016 to March 2023 were retrospectively analyzed.RESULTS A total of 234 patients were included in our study.The duration of symptoms and the presence of an appendicolith were significantly correlated with the occurrence of peri-appendiceal abscess in patients with acute complicated appendicitis(P<0.001 and P=0.015,respectively).Patients with symptoms lasting longer than 72 h had a significantly longer postoperative LOS compared to those with symptoms lasting 72 h or less[hazard ratio(HR),1.208;95%CI:1.107-1.319;P<0.001].Additionally,patients with peri-appendiceal abscesses had a significantly longer postoperative LOS compared to those with phlegmon(HR,1.217;95%CI:1.095-1.352;P<0.001).The patients with peri-appendiceal abscesses were divided into two groups based on the median size of the abscess:Those with abscesses smaller than 5.0 cm(n=69)and those with abscesses 5.0 cm or larger(n=82).Patients with peri-appendiceal abscesses measuring 5.0 cm or larger had a significantly longer postoperative LOS than those with abscesses smaller than 5.0 cm(P=0.038).CONCLUSION The duration of symptoms and the presence of an appendicolith are significant risk factors for the formation of peri-appendiceal abscesses in patients with acute complicated appendicitis.Patients with peri-appendiceal abscesses experience a significantly longer postoperative LOS compared to those with peri-appendiceal phlegmon.
文摘BACKGROUND Acute appendicitis is one of the most common emergency abdominal disease,and recent studies have evaluated conservative treatment using antibiotics for uncomplicated appendicitis.Although the efficacy of conservative treatment for uncomplicated appendicitis is known,its efficacy for complicated appendicitis remains unknown,so are risk factors for the conservative treatment of appendi-citis.In our institution,conservative treatment has long been the first choice for most appendicitis cases,except for perforation.Therefore,this novel study inves-tigated the outcomes of conservative treatment for uncomplicated and compli-cated acute appendicitis and the risk factors associated with conservative treat-ment.treatment.The significant and independent predictors of resistance to conservative treatment were body temperature≥37.3℃,appendicolith and Douglas sinus fluid visible on computed tomography(CT).The rate of resistance to conservative treatment was 66.7%(6/9)for patients with the above three factors,22.9%(8/35)for patients with two factors(appendicolith and body temperature≥37.3℃),16.7%(2/12)for patients with two factors(Douglas sinus fluid and appendicolith)and 11.1%(1/9)for patients with two factors(Douglas sinus fluid and body temperature≥37.3℃).CONCLUSION A temperature≥37.3℃,appendicolith and Douglas sinus fluid on CT might be clinical risk factors of resistance to conservative treatment for acute appendicitis.
基金supported by a grant(2017-0202)from Asan Medical Center Children's hospital,Seoul,South Korea.
文摘Background Appendicolith can cause appendiceal obstruction and acute appendicitis.Its high prevalence may be related to the high perforation rate in pediatric appendicitis.This study assessed the characteristics of appendicolith and its clinical significance in pediatric appendicitis.Methods A retrospective study was performed among children and adolescents younger than 17 years who were preopera-tively diagnosed with appendicitis in the pediatric emergency department(ED).A total of 269 patients with a mean age of 9.98±3.37 years were enrolled.Clinical features and contrast-enhanced computed tomography findings were analyzed.Results Among the 269 patients,147(54.6%)had appendicoliths,with a mean maximal diameter of 5.21±2.34 mm.Com-pared to the no appendicolith group,the appendicolith group demonstrated more prolonged abdominal pain(≥48 hours)before the ED visit(23.1%vs.11.5%;P=0.013),clinical features of severe appendicitis(presence of fever,vomiting,posi-tive urine ketone,and increased C-reactive protein),and higher rate of perforation(43.5%vs.9.8%;P<0.001).Multivariate risk factor analysis for perforated appendicitis in the appendicolith group revealed that maximal diameter of 5 mm or more in the appendicolith(adjusted odds ratio[aOR]2.919;95%CI 1.325-6.428,P=0.008)and proximal collapse adjacent to the appendicolith(aOR 2.943;95%CI 1.344-6.443,P=0.007)were significant.Conclusions Pediatric appendicitis with appendicolith often presents with prolonged abdominal pain and severe clinical conditions with a high risk of perforation.
文摘Introduction: The appendix is identified as blind ending tubular structure arising from caecum and has variable intraluminal contents and position. Acute appendicitis is one of the common indications for emergency imaging studies. Aim: To describe the importance of appendix hyperattenuation and densities. Material and Methods: Contrast enhanced computed tomography images of abdomen from 120 patients with surgically/pathological proven acute appendicitis, were examined retrospectively. The images were reviewed in axial, coronal and sagittal reformations for assessing the intraluminal contents (hyperdensity and appendicolith), maximum transverse diameter and single wall thickness of appendix, periappendiceal fat stranding and other parameters related to acute appendicitis. In addition, reviewing 100 pre- and post-contrast CT scans of other abdominal conditions as a control group for documenting hyperdense appendix, appendicolith and other signs of appendicitis. Results: The hyperdense appendix sign was found in 5 patients in our study, not found in any patient of the control group (P value = 0.039, is statistically), appendicolith was found in 25% in patients with acute appendicitis, in 3% in control group (statistically significant, p < 0.0001). Conclusion: The hyperdense appendix and appendicolith have strong association with acute appendicitis in the appropriate clinical setting.
