Is appendoscope a new option for the treatment of acute appendicitis?

Acute appendicitis is a common surgical emergency.It is commonly caused by obstruction of the appendiceal lumen due to fecaliths,tumors,or lymphoid hyperplasia.For over a century,appendectomy has been the primary treatment for acute appendicitis.Abraham Groves performed the first open appendectomy in 1883.In 1983,Kurt Semm completed the first laparoscopic appendectomy,heralding a new era in appendectomy.However,appendectomy is associated with certain complications and a rate of negative appendectomies.Studies have suggested controversy over the impact of appendectomy on the development of inflammatory bowel disease and Parkinson’s disease,but an increasing number of studies indicate a possible positive correlation between appendectomy and colorectal cancer,gallstones,and cardiovascular disease.With the recognition that the appendix is not a vestigial organ and the advancement of endoscopic technology,Liu proposed the endoscopic retrograde appendicitis therapy.It is an effective minimally invasive alternative for treating uncomplicated acute appendicitis.Our team has developed an appendoscope with a disposable digital imaging system operated through the biopsy channel of a colonoscope and successfully applied it in the treatment of appendicitis.This article provides an overview of the progress in endoscopic treatment for acute appendicitis and offers a new perspective on the future direction of appendiceal disease treatment.

Indication of conservative treatment by antibiotics for uncomplicated and complicated acute appendicitis

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.

Appendicitis combined with Meckel’s diverticulum obstruction, perforation, and inflammation in children: Three case reports

BACKGROUND Meckel’s diverticulum is a common congenital malformation of the small intestine,with the three most common complications being obstruction,per-foration,and inflammation.To date,only a few cases have been reported world-wide.In children,the clinical symptoms are similar to appendicitis.As most of the imaging features are nonspecific,the preoperative diagnosis is not precise.In addition,the clinical characteristics are highly similar to pediatric acute appendicitis,thus special attention is necessary to distinguish Meckel’s diver-ticulum from pediatric appendicitis.Patients with poor disease control should undergo laparoscopic exploration to avoid serious complications,including intestinal necrosis,intestinal perforation and gastrointestinal bleeding.CASE SUMMARY This report presents three cases of appendicitis in children combined with intestinal obstruction,which was caused by fibrous bands(ligaments)arising from the top part of Meckel's diverticulum,diverticular perforation,and diver-ticular inflammation.All three patients,aged 11-12 years,had acute appendicitis as their initial clinical presentation.All were treated by laparoscopic surgery with a favorable outcome.A complete dataset including clinical presentation,dia-gnostic imaging,surgical information,and histopathologic findings was also provided.CONCLUSION Preoperative diagnosis of Meckel’s diverticulum and its complications is challenging because its clinical signs and complications are similar to those of appendicitis in children.Laparoscopy combined with laparotomy is useful for diagnosis and treatment.

Endoscopic retrograde appendicitis treatment for periappendiceal abscess: A case report

BACKGROUND Acute appendicitis is the most common abdominal emergency.At present,the main treatments for periappendiceal abscess include antibiotics and surgery.However,the complications and mortality of emergency surgery are high.The preferred therapy is conservative treatment with antibiotics first,ultrasound-guided puncture drainage or surgical treatment is followed when necessary.Endoscopic retrograde appendicitis therapy(ERAT)for acute uncomplicated appendicitis have been proved clinically effective,but it is rarely used in periap-pendiceal abscess.CASE SUMMARY We report a patient admitted to hospital because of“right lower abdominal pain for six days”.The computerized tomography(CT)of patient showed that appendicitis with fecaliths and abscess in the pelvis.The patient was treated by CT-guided puncture and drainage of abdominal abscess combined with ERAT to remove appendiceal fecaliths,irrigation and stent placement.CONCLUSION The patient did not receive surgery because of impoverished family.Abdominal pain did not recur during the follow-up period.This case confirms the value of ERAT in the treatment of periappendiceal abscess.

Influence of sarcopenia and frailty in the management of elderly patients with acute appendicitis

In developed countries,the average life expectancy has been increasing and is now well over 80 years.Increased life expectancy is associated with an increased number of emergency surgical procedures performed in later age groups.Acute appendicitis is one of the most common surgical diseases,with a lifetime risk of 8%.A growing incidence of acute appendicitis has been registered in the elderly population and in the oldest groups(>80 years).Among patients>50-year-old who present to the emergency department for acute abdominal pain,15%have acute appendicitis.In these patients,emergency surgery for acute appendicitis is challenging,and some important aspects must be considered.In the elderly,surgical treatment outcomes are influenced by sarcopenia.Sarcopenia must be considered a precursor of frailty,a risk factor for physical function decline.Sarcopenia has a negative impact on both elective and emergency surgery regarding mortality and morbidity.Aside from morbidity and mortality,the most crucial outcomes for older patients requiring emergency surgery are reduction in function decline and preoperative physical function maintenance.Therefore,prediction of function decline is critical.In emergency surgery,preoperative interventions are difficult to implement because of the narrow time window before surgery.In this editorial,we highlight the unique aspects of acute appendicitis in elderly patients and the influence of sarcopenia and frailty on the results of surgical treatment.

Added value of ratio of cross diameters of the appendix in ultrasound diagnosis of acute appendicitis

BACKGROUND The maximum outer diameter(MOD)of the appendix is an essential parameter for diagnosing acute appendicitis,but there is space for improvement in ultrasound(US)diagnostic performance.AIM To investigate whether combining the ratio of the cross diameters(RATIO)of the appendix with MOD of the appendix can enhance the diagnostic performance of acute appendicitis.METHODS A retrospective study was conducted,and medical records of 233 patients with acute appendicitis and 112 patients with a normal appendix were reviewed.The MOD and RATIO of the appendix were calculated and tested for their diagnostic performance of acute appendicitis,both individually and in combination.RESULTS The RATIO for a normal appendix was 1.32±0.16,while for acute appendicitis it was 1.09±0.07.The cut-off value for RATIO was determined to be≤1.18.The area under the receiver operating characteristic curve(AUC)for diagnosing acute appendicitis using RATIO≤1.18 and MOD>6 mm was 0.870 and 0.652,respectively.There was a significant difference in AUC between RATIO≤1.18 and MOD>6 mm(P<0.0001).When comparing the combination of RATIO≤1.18 and MOD>6 mm with MOD>6 mm alone,the combination showed increased specificity,positive predictive value(PPV),and AUC.However,the sensitivity and negative predictive value decreased.CONCLUSION Combining RATIO of the appendix≤1.18 and MOD>6 mm can significantly improve the specificity,PPV,and AUC in the US diagnosis of acute appendicitis.

Clinical significance of peri-appendiceal abscess and phlegmon in acute complicated appendicitis patients undergoing emergency appendectomy

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.

Evaluation of the clinical effects of atropine in combination with remifentanil in children undergoing surgery for acute appendicitis

BACKGROUND Acute appendicitis(AA)is the most common cause of acute abdomen in children.Anesthesia significantly influences the surgical treatment of AA in children,making the scientific and effective selection of anesthetics crucial.AIM To assess the clinical effect of atropine(ATR)in combination with remifentanil(REMI)in children undergoing surgery for AA.METHODS In total,108 cases of pediatric AA treated between May 2020 and May 2023 were selected,58 of which received ATR+REMI[research group(RG)]and 50 who received REMI[control group(CG)].Comparative analyses were conducted on the time to loss of eyelash reflex,pain resolution time,recovery time from anesthesia,incidence of adverse events(AEs;respiratory depression,hypoxemia,bradycardia,nausea and vomiting,and hypotension),intraoperative responses(head shaking,limb activity,orientation recovery,safe departure time from the operating room),hemodynamic parameters[oxygen saturation(SPO2),mean arterial pressure,heart rate,and respiratory rate],postoperative sedation score(Ramsay score),and pain level[the Face,Legs,Activity,Cry,Consolability(FLACC)Behavioral Scale].RESULTS Compared with the CG,the RG showed significantly shorter time to loss of eyelash reflex,pain resolution,recovery from anesthesia,and safe departure from the operating room.Furthermore,the incidence rates of overall AEs(head shaking,limb activity,etc.)were lower,and influences on intraoperative hemodynamic parameters and stress response indexes were fewer.The Ramsay score at 30 min after extubation and the FLACC score at 60 min after extubation were significantly lower in the RG than in the CG.CONCLUSION ATR+REMI is superior to REMI alone in children undergoing AA surgery,with a lower incidence of AEs,fewer influences on hemodynamics and stress responses,and better post-anesthesia recovery.

Modified technical protocol for single-port laparoscopic appendectomy using needle-type grasping forceps for acute simple appendicitis:A case report

BACKGROUND Because of the mild inflammatory status in acute uncomplicated appendicitis,our team developed a novel technical protocol for single-port laparoscopic appendec-tomy using needle-type grasping forceps(SLAN)and achieved positive clinical outcomes.However,the intraoperative procedure lacked stability and fluency due to a series of problems highlighted by the small incision design of the proto-col(only 1 cm long).Therefore,there is a growing clinical demand to further opti-mize the SLAN protocol.CASE SUMMARY An adult male patient was admitted for persistent right lower abdominal pain with preoperative computed tomography findings suggestive of appendicitis accompanied by localized peritonitis.A modified technical protocol for SLAN based on minimally invasive surgical principles was used,and the patient was confirmed to have acute simple appendicitis by postoperative pathological ana-lysis.Postoperative recovery was uneventful,and no postoperative complications,such as incision infection or severe incision pain,were observed.The patient was discharged successfully on postoperative day 2.CONCLUSION The modified technical protocol of SLAN may be a new minimally invasive surgical alternative for patients with acute simple appendicitis.

Systemic immune-inflammation index combined with pediatric appendicitis score in assessing the severity and prognosis for paediatric appendicitis

BACKGROUND Pediatric appendicitis is a common cause of abdominal pain in children and is recognized as a significant surgical emergency.A prompt and accurate diagnosis is essential to prevent complications such as perforation and peritonitis.AIM To investigate the predictive value of the systemic immune-inflammation index(SII)combined with the pediatric appendicitis score(PAS)for the assessment of disease severity and surgical outcomes in children aged 5 years and older with appendicitis.METHODS Clinical data of 104 children diagnosed with acute appendicitis were analyzed.The participants were categorized into the acute appendicitis group and chronic appendicitis group based on disease presentation and further stratified into the good prognosis group and poor prognosis group based on prognosis.The SII and PAS were measured,and a joint model using the combined SII and PAS was constructed to predict disease severity and surgical outcomes.RESULTS Significant differences were observed in the SII and PAS parameters between the acute appendicitis group and chronic appendicitis group.Correlation analysis showed associations among the SII,PAS,and disease severity,with the combined SII and PAS model demonstrating significant predictive value for assessing disease severity[aera under the curve(AUC)=0.914]and predicting surgical outcomes(AUC=0.857)in children aged 5 years and older with appendicitis.CONCLUSION The study findings support the potential of integrating the SII with the PAS for assessing disease severity and predicting surgical outcomes in pediatric appendicitis,indicating the clinical utility of the combined SII and PAS model in guiding clinical decision-making and optimizing surgical management strategies for pediatric patients with appendicitis.

Bilharzia Appendicitis: Incidence in a Commune in Mali, about 3CAS

Appendicitis bilharzia is a very rare condition and we report 3 cases of this pathology that sense clinical and biological similarities with bacterial appendicitis. The etiological diagnosis was exclusively histopathological, this allowed to highlight eggs of Schistosome in the appendicular wall in the three patients. The surgical treatment was supplemented by a specific medical treatment based on praziquantel. The surgical suites were simple for 2 patients, complicated by superficial parietal suppuration in a patient.

Analysis of the Clinical Value of Surgical Treatment and Postoperative Anti-Infection Treatment of Acute Suppurative Appendicitis

Objective: To explore the clinical value of surgical treatment and postoperative anti-infection treatment for acute suppurative appendicitis. Methods: A total of 116 patients with acute suppurative appendicitis were enrolled in this study. The collection period was from December 2021 to December 2023. The patients were randomly grouped into a control group (surgical treatment) and an observation group (surgical treatment and postoperative anti-infection treatment), of 58 patients each. At the end of the treatment, the results of each index of the two groups were compared. Results: The length of hospitalization time, exhaust time, and incidence of complications in the observation group were shorter than those of the control group (P < 0.05). The total effective rate of the observation group was higher than that of the control group (P < 0.05). Conclusion: It is crucial to perform anti-infective treatment promptly after surgical treatment in patients with acute suppurative appendicitis. It can effectively prevent the occurrence of complications and improve the clinical efficacy. Hence, it is worthy of research and promotion.

Systemic inflammation response index and systemic immune-inflammation index for predicting complications of acute appendicitis:A retrospective study

Objective:To investigate the value of systemic inflammatory response index(SIRI)and systemic immune-inflammation index(SII)in predicating acute appendicitis complications based on hemogram parameters.Methods:Demographic data,histopathological studies,and laboratory results of the patients who were admitted to the emergency department with a complaint of abdominal pain between January 2020 and June 2022 and were hospitalized with the diagnosis of acute appendicitis for operation by general surgery were examined.Simple appendicitis and complicated appendicitis groups were compared in terms of parameters according to their histopathological examinations.Results:A total of 220 patients who met the inclusion criteria were included in our study.Mean SIRI levels were found to be significantly higher in the complicated appendicitis group than in the simple appendicitis group[6.60(4.07,14.40)vs.3.50(2.20,6.80);P=0.002].Similarly,SII levels were found to be significantly higher in the complicated appendicitis group compared to the simple appendicitis group[2514.50(1132.25,5388.00)vs.1207.00(571.50,2089.00),P<0.001].The power of SIRI and SII to indicate complications was higher than white blood cell count and C-reactive protein(area under the curve:0.753 and 0.786,respectively).Conclusion:SIRI and SII could be used to indicate complications in patients with acute appendicitis.

Colonoscopy-induced acute appendicitis: A case report

BACKGROUND Colonoscopy is widely used for examination,diagnosis,and treatment because of its low incidence of associated complications.Post-colonoscopy appendicitis(PCA)is very rare and is easily misdiagnosed as electrocoagulation syndrome or colon perforation.Therefore,clinicians should pay close attention to this complication.CASE SUMMARY A 47-year-old female patient underwent a colonoscopy for a systematic physical examination,and the procedure was uneventful with normal endoscopic and histologic findings.However,the bowel preparation was suboptimal(Boston 2-3-2).After the examination,the patient experienced pain in the lower abdomen,which progressively worsened.Computed tomography of the lower abdomen and pelvis revealed appendiceal calcular obstruction and appendicitis.As the patient refused surgery,she was managed with antibiotics and recovered well.CONCLUSION In the current literature,the definition of PCA remains unclear.However,abdominal pain after colonoscopy should be differentiated from acute appen-dicitis.

Acute peritonitis secondary to post-traumatic appendicitis:A case report and literature review

BACKGROUND Blunt abdominal trauma has rarely been reported as a cause of acute appendicitis in the literature.However,the coexistence of the two conditions can cause issues for the patient.We present here a systematic review of cases of traumatic appendicitis as well as our own experience with a 12-year-old male patient.CASE SUMMARY A 12-year-old male was admitted 3 d after abdominal trauma,experiencing peritoneal syndrome.A pelvic formation was discovered during abdominal ultrasound,and surgical exploration revealed a perforated appendix.A literature review was conducted applying the keywords“appendicitis,”“abdominal,”and“trauma”to the PubMed,Embase,and Medline databases.Our initial search included 529 papers published between 1991 and 2022,of which 33 papers were finally included.They revealed 51 reported cases.The trauma mechanisms included road traffic accidents,falls,assaults,ball accidents,a horse kick,and a colonoscopy.Eight patients underwent surgical exploration with no prior radiological investigation,and twenty-six patients underwent an initial radiological examination.All reports indicated a perforated appendix.CONCLUSION Acute traumatic appendicitis represents a diagnostic quandary that can be misdiagnosed resulting in significant morbidity and potential mortality.A high level of suspicion combined with radiological examination may aid in the diagnosis and treatment of this condition.

Epidemiological, Clinical, and Therapeutic Characteristics of Acute Appendicitis at the Reference Health Center in Commune I of the District of Bamako Mali

Acute appendicitis is the most common abdominal surgical emergency. This work is a prospective study from January 2012 to December to analyze the epidemiological, clinical and therapeutic aspects of acute appendicitis in the Cs ref of commune I of the district of Bamako and the results obtained were then compared with those reported in other countries. Our study included 72 patients. The appendectomy surgical specimens were the subject of an anatomical pathology study at Point G University Hospital in Bamako in Mali, 1.4% of cases of which were healthy. All our operated patients received antibiotics (mono or dual antibiotics) with a post-operative hospitalization duration of 1.5 (36 hours) days on average. We recorded 6 complications such as parietal suppuration, i.e. 8.33% of cases. No 5th day syndrome or late complications were noted. The average length of hospitalization was 36 hours. Abdominal ultrasound;used as an additional examination was carried out in 55 of our patients or 76.39% of cases. We have not recorded any deaths. Raising awareness among patients about the dangers of complications motivated patients to undergo surgery as soon as possible.

Epidemiological-Clinical and Therapeutic Aspects of Acute Appendicitis at the Reference Health Center of Commune III (C.S.Ref CIII) of the District of Bamako

Objectives: It was to determine the epidemiological-clinical and therapeutic aspects of acute appendicitis at the Reference Health Center of Commune III of the district of Bamako. Methodology: This was a prospective study from January 1 to December 31, 2020 including patients operated for acute appendicitis and confirmed at histology and cases of abscess and appendicular plastron. Results: We collected 60 cases of acute appendicitis. They accounted for 17.29% of surgical indications. The average age of our patients was 25.5 years. The male sex was the most represented at 63% with a sex ratio of 1.72. The Pain in the right iliac fossa was the most represented reason for consultation with 76.7%. It was at the type of bite 70% of the cases. On physical examination the defense of the right iliac fossa was present in 96.7%. Digestive signs were marked by nausea 28.4% (17 patients) and vomiting 25% (15 patients). The digital rectal exam was painful to the right of the Douglas fir in 76.7% of our patients. In biology a complete blood count (CBC) performed in all our patients has objectified hyper leukocytosis in 80% of cases. The reactive protein (CRP) performed in 36 patients was elevated with values between 18 and 46 mg/ml. The imaging performed was an abdominal ultrasound that found a roundel image of the appendix with increased size in 65%. Surgical treatment consisted of classical Mac Burney appendectomy in 54 patients (90%). The gesture performed was an appendectomy in all our patients. All our appendectomy parts were sent for pathological examination. This examination classified the parts as non-specific appendicitis in 60%, phlegmonous appendicitis in 22% and catarrhal appendicitis in 18% of cases. Surgical follow-up was simple in 98.4% (59 patients) and morbidity was marked by digestive fistula in one patient. We recorded one case of death (1.6%). Conclusion: Acute appendicitis remains the most common surgical emergency in commune III of the district of Bamako. It is a pathology that can be found at all ages of life. Its morbidity and mortality are low subject to early diagnosis and management.

Unusual Cause of Acute Appendicitis: Bone Fragment

Foreign bodies are a rare cause of appendicitis, because in most cases these ingested foreign bodies cross the digestive tract asymptomatically [1] [2] [3]. However, some penetrate the lumen of the appendix causing its inflammation. We report an unusual observation of acute appendicitis induced by a foreign body namely a bone fragment in the visceral surgery department of the Centre Hospitalier Intercommunal de Villeneuve Saint-Georges.

Analysis of the Effectiveness of Laparoscopic Appendectomy Compared to Laparotomy in the Treatment of Acute Appendicitis

Objective:To analyze the clinical effects of laparoscopic appendectomy compared to traditional laparotomy in treating acute appendicitis.Methods:90 patients with acute appendicitis were selected as research subjects.They were divided into a control group and an observation group,with 45 cases in each group.The control group underwent traditional laparotomy,while the observation group underwent laparoscopic appendectomy.The intraoperative indicators,postoperative recovery indicators,postoperative stress indicators,and postoperative complications of the two groups were compared.Results:The operative time of the observation group was longer,but the incision length was shorter and the blood loss was lesser(P<0.05);the observation group had shorter postoperative first gas-passing time,recovery of gastrointestinal function,ambulation time,and lower postoperative pain score.The observation group had lower postoperative stress index levels(P<0.05);the observation group had a lower postoperative complication rate(P<0.05).Conclusion:Aside from prolonging the operative time,laparoscopic appendectomy is more ideal than traditional laparotomy in all other indicators and has better therapeutic effects in treating acute appendicitis.

Are acute exacerbations of chronic inflammatory appendicitis triggered by coprostasis and/or coproliths?

AIM: To examine the role of coprostasis and coproliths in recurrent appendicitis. METHODS: We evaluated four hundred and twenty seven consecutive pathology reports of all appende- ctomy specimens from January 2003 to December 2004. Findings were categorised as showing acute appen- dicitis, acute recurrent appendicitis, subacute recurrent appendicitis, chronic appendicitis, or appendices without inflammation. All patients had presented with acute right lower quadrant pain. In 94 instances, there was a history of recurrent similar episodes in the past. RESULTS: Of the 427 histology reports, 294 were inter- preted as showing acute appendicitis, 56 acute recurrent appendicitis, 34 subacute recurrent appen-dicitis, 28 chronic appendicitis, and 15 non-inflamed appendices. Coprostasis was observed in 58 patients (13.58%) and the presence of coprolith in 6 (1.4%). Coprostasis, and age, were among the predictors in the final model. CONCLUSION: Coprostasis but not coproliths seems to be a contributing factor to acute exacerbations of chronic inflammatory appendicitis.