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.

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.

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.

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.

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.

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.

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.

Epstein-Barr virus infection mimicking acute appendicitis: a case report

Dear editor,Epstein-Barr virus (EBV) infection is common, and more than 90%of adults develop serum EBV antibodies over the course of life.[1]After the first EBV infection, a longterm latent infection develops, which is followed by B-cell infections in instances when the function of the resistance mechanisms of the body weakens.

Endoscopic treatment for acute appendicitis with coexistent acute pancreatitis: Two case reports

BACKGROUND Appendectomy is the procedure of choice for the treatment of acute appendicitis.However,surgery may not be appropriate for patients with coexisting severe illness or comorbidities such as acute pancreatitis(AP).Endoscopic retrograde appendicitis treatment(ERAT)may be a novel alternative to surgery for treating such patients where existing medical therapies have failed.CASE SUMMARY We report 2 cases of moderately severe AP who developed acute uncomplicated appendicitis during their hospital stay and did not respond to traditional medical therapy.One patient had moderately severe AP due to hyperlipidemia,while the other patient had a gallstone induced by moderately severe AP.Neither patient was fit to undergo an appendectomy procedure because of the concurrent AP.Therefore,the alternative and minimally invasive ERAT was considered.After written informed consent was collected from the patients,the ERAT procedure was performed.Both patients exhibited fast postoperative recovery after ERAT with minimal surgical trauma.CONCLUSION ERAT is a safe and effective minimally invasive endoscopic procedure for acute appendicitis in patients with coexistent AP.

Is endoscopic retrograde appendicitis therapy a better modality for acute uncomplicated appendicitis? A systematic review and metaanalysis

BACKGROUND Previous studies had shown endoscopic retrograde appendicitis therapy(ERAT)is an effective treatment for acute appendicitis.However,different studies reported conflicting outcomes regarding the effectiveness of ERAT in comparison with laparoscopic appendectomy(LA).AIM To compare the effectiveness of ERAT with LA.METHODS Randomized controlled trials(RCTs)and retrospective studies of ERAT for acute uncomplicated appendicitis were searched in PubMed,Cochrane Library,Web of Science,Embase database,China National Knowledge Infrastructure(CNKI),the WanFang Database,and Chinese Scientific Journals Database(VIP)from the establishment date to March 12021.Heterogeneity was assessed using the Isquared statistic.Pooled odds ratios(OR),weighted mean difference(WMD),and standard mean difference(SMD),with 95%confidence intervals(CI)were calculated through either fixed-effects or random-effects model.Sensitivity analysis was also performed.Publication bias was tested by Egger's test,and Begg’s test.The quality of included RCT were evaluated by the Jadad scale,while Newcastle-Ottawa scale is adopted for assessing the methodological quality of case-control studies.All statistical analysis was performed using Stata 15.1 statistical software.All statistical analysis was performed using Stata 15.1 statistical software.This study is registered with PROSPERO,CRD42021243955.RESULTS After screening,10 RCTs and 2 case-control studies were included in the current systematic review.Firstly,the length of hospitalizations[WMD=-1.15,95%CI:-1.99,-0.31;P=0.007]was shorter than LA group.Secondly,the level of postoperative CRP[WMD=-10.06,95%CI:(-17.39,-2.73);P=0.007],TNF-α[WMD=-7.70,95%CI:(-8.47,-6.93);P<0.001],and IL-6 Levels[WMD=-9.78,95%CI:(-10.69,-8.88);P<0.001;P<0.001]in ERAT group was significantly lower than LA group.Thirdly,ERAT group had a lower incidence of intestinal obstruction than LA group.[OR=0.19,95%CI:(0.05,0.79);P=0.020].Moreover,the quality of 10 RCTs were low with 0-3 Jadad scores,while the methodological quality of two case-control studies were fair with a score of 2(each).CONCLUSION Compared with LA,ERAT reduces operation time,the level of postoperative inflammation,and results in fewer complications and shorter recovery time,with preserving the appendix and its immune and biological functions.

Managing acute appendicitis during the COVID-19 pandemic in Jiaxing, China

BACKGROUND Coronavirus disease 19(COVID-19)is a global pandemic and has had a profound impact on our routine surgical activities.Acute appendicitis is the most common abdominal emergency worldwide.Therefore,it is highly essential to assess the influence the pandemic has on acute appendicitis.AIM To assess the efficacy of the management of acute appendicitis during the COVID-19 pandemic.METHODS We retrospectively analyzed 90 patients who presented with acute appendicitis during the outbreak of COVID-19 in Jiaxing,China.Clinical data regarding appendectomies patients were also collected for the corresponding time frame from 2019.Preoperative management,intraoperative protective measures,and postoperative management were conducted.RESULTS After screening,six patients were identified as unqualified due to fever and were then referred to the COVID-19 expert group.The results of the nucleic acid test were negative.Of the 76 patients enrolled in the simple group,nine patients received medication therapy,and all others underwent surgery.From this same group,66 patients were diagnosed with suppurative appendicitis,and one patient was diagnosed with perforated appendicitis after surgery.There were 14 patients in the complex group,for which the postoperative diagnosis indicated perforated appendicitis.The proportion of men with perforated appendicitis was higher than that in 2019(P<0.05).The chief complaint duration for perforated appendicitis patients in 2020 was longer than that in 2019(P<0.05).The routine blood test showed that white blood cell counts and neutrophil ratios were higher in perforated appendicitis patients in 2020 than in 2019(P<0.05).The ratio of open appendectomies to the amount of mean blood loss during surgery was greater in 2020 than in 2019(P<0.05).Online consultation after discharge was selected in 59 cases(65.6%).No perioperative infection with COVID-19 or long-term postoperative complications were found.CONCLUSION The management of acute appendicitis from Jiaxing effectively reduced the influence of the pandemic and minimized the risk of nosocomial infection.

Effect of the COVID-19 pandemic on patients with presumed diagnosis of acute appendicitis

BACKGROUND Acute appendicitis(AAp) is the most frequent cause of acute abdominal pain,and appendectomy is the most frequent emergency procedure that is performed worldwide.The coronavirus disease 2019(COVID-19) pandemic has caused delays in managing diseases requiring emergency approaches such as AAp and trauma.AIM To compare the demographic,clinical,and histopathological outcomes of patients with AAp who underwent appendectomy during pre-COVID-19 and COVID-19 periods.METHODS The demographic,clinical,biochemical,and histopathological parameters were evaluated and compared in patients who underwent appendectomy with the presumed diagnosis of AAp in the pre-COVID-19(October 2018-March 2020) and COVID-19(March 2020-July 2021) periods.RESULTS Admissions to our tertiary care hospital for AAp increased 44.8% in the COVID-19 period.PreCOVID-19(n = 154) and COVID-19(n = 223) periods were compared for various parameters,and we found that there were statistically significant differences in terms of variables such as procedures performed on the weekdays or weekends [odds ratio(OR):1.76;P = 0.018],presence of AAp findings on ultrasonography(OR:15.4;P < 0.001),confirmation of AAp in the histopathologic analysis(OR:2.6;P = 0.003),determination of perforation in the appendectomy specimen(OR:2.2;P = 0.004),the diameter of the appendix(P < 0.001),and hospital stay(P = 0.003).There was no statistically significant difference in terms of interval between the initiation of symptoms and admission to the hospital between the pre-COVID-19(median:24 h;interquartile range:34) and COVID-19(median:36 h;interquartile range:60) periods(P = 0.348).The interval between the initiation of symptoms until the hospital admission was significantly longer in patients with perforated AAp regardless of the COVID-19 or pre-COVID-19 status(P < 0.001).CONCLUSION The present study showed that in the COVID-19 period,the ultrasonographic determination rate of AAp,perforation rate of AAp,and duration of hospital stay increased.On the other hand,negative appendectomy rate decreased.There was no statistically significant delay in hospital admissions that would delay the diagnosis of AAp in the COVID-19 period.

Seasonal variations of acute appendicitis and nonspecific abdominal pain in Finland

AIM:To investigate whether seasonal changes had an effect on the incidence of acute appendicitis(AA)or nonspecific abdominal pain(NSAP).METHODS:We carried out a national register study of all patients with a hospital discharge diagnosis of AA and acute NSAP in Finland.Data were analyzed for the whole country and correlated to seasonal and weather parameters(temperature,humidity).Moreover,additional sub-analyses were performed for five geographically different area of Finland.RESULTS:The observation period spanned 21 years,with 186558 appendectomies,of which 137528(74%)cases were reported as AA.The incidence of AA declined for 32%over the study period.The average incidence of the NSAP was 34/10000 per year.The mean annual temperature,but not relative humidity,showed clear geographical variations.The incidence of AA decreased significantly during the cold months of the year.No correlation was detected between temperature and incidence of NSAP.Humidity had a statistically significant impact on NSAP.CONCLUSION:The incidence of acute appendicitis is declining in Finland.We detected a clear seasonality in the incidence of AA and NSAP.

Clinical and computed tomography findings of appendiceal diverticulitis vs acute appendicitis

AIM: To study the clinical features and computed tomography(CT) findings of appendiceal diverticulitis vs acute appendicitis.METHODS: We retrospectively reviewed the records of 451 patients who had undergone appendectomy inour in stitution from January 2007 to September 2012. Patient demographics, clinical features, pathological findings, and surgical outcomes were analyzed. We also compared preoperative CT images of 25 patients with appendiceal diverticulitis with those of 25 patients with acute appendicitis.RESULTS: Among 451 patients, 44(9.7%) were diagnosed to have appendiceal diverticulitis and 398(86.9%) to have acute appendicitis. Patients with appendiceal diverticulitis were older(59 vs 37 years, P < 0.001) and had a longer duration of the illness(4.0 d vs 1.0 d, P < 0.001). Perforation rates in patients with appendiceal diverticulitis were higher(68% vs 27%, P < 0.001). The appendix could be visualized in only 13 patients(52%) among the appendiceal diverticulitis cases, but in all acute appendicitis cases. CT findings suggestive of appendiceal diverticulitis included the absence of fluid collection in the appendix(84% vs 12%, P < 0.001), absence of appendicolith(92% vs 52%, P = 0.005), and formation of abscess(68% vs 16%, P < 0.001). Appendiceal diverticula were identified in 6 patients(24%).CONCLUSION: Among patients who had undergone appendectomy, 9.7% had appendiceal diverticulitis. Patients with appendiceal diverticulitis had different clinical features and CT findings from patients with acute appendicitis.

Unusual histopathological findings in appendectomy specimens from patients with suspected acute appendicitis

AIM: To investigate the prevalence and implications of unusual histopathological findings in appendectomy specimens from patients with suspected acute appendicitis. METHODS: The demographic and histopathological data of 1621 patients (≥ 16 years-old) who underwent appendectomy to treat an initial diagnosis of acute appendicitis between January 1999 and November 2011 were retrospectively assessed. Microscopic findings were used to classify the patients under six categories: appendix vermiformis, phlegmonous appendicitis, gan- grenous appendicitis, perforated appendicitis, supurative appendicitis, and unusual histopathologic findings. The demographic and clinicopathologic characteristics of patients with unusual histopathologic findings were evaluated in detail, and re-analysis of archived resected appendix specimens was carried out. RESULTS: A total of 912 males and 709 females, from16 to 94 years old, were included in the study and comprised 789 cases of suppurative appendicitis, 370 cases of appendix vermiformis, 243 cases of perforated gangrenous appendicitis, 53 cases of flegmaneous appendicitis, 32 cases of gangrenous appendicitis, and 134 (8.3%) cases of unusual histopathological findings. The unusual histopathological findings included fibrous obliteration (n = 62), enterobius vermicularis (n = 31), eosinophilic infiltration (n = 10), mucinous cystadenoma (n = 8), carcinoid tumor (n = 6), granulomatous inflammation (n = 5), adenocarcinoma (n = 4; one of them mucinous), and mucocele (n = 3), adenomatous polyp (n = 1), taenia sup (n = 1), ascaris lumbricoides (n = 1), appendiceal diverticula (n = 1), and B cell non-hodgkin lymphoma (n = 1). None of the 11 patients with subsequent diagnosis of tumor were suspected of cancer prior to the appendectomy. CONCLUSION: Even when the macroscopic appearance of appendectomy specimens is normal, histopathological assessment will allow early diagnosis of many unusual diseases.

Evaluation of modifi ed Alvarado scoring system and RIPASA scoring system as diagnostic tools of acute appendicitis

BACKGROUND: Acute appendicitis is the most common surgical condition presented in emergency departments worldwide. Clinical scoring systems, such as the Alvarado and modified Alvarado scoring systems, were developed with the goal of reducing the negative appendectomy rate to 5%–10%. The Raja Isteri Pengiran Anak Saleha Appendicitis(RIPASA) scoring system was established in 2008 specif ically for Asian populations. The aim of this study was to compare the modif ied Alvarado with the RIPASA scoring system in Kuwait population.METHODS: This study included 180 patients who underwent appendectomies and were documented as having "acute appendicitis" or "abdominal pain" in the operating theatre logbook(unit B) from November 2014 to March 2016. The sensitivity, specificity, positive predictive value(PPV), negative predictive value(NPV), diagnostic accuracy, predicted negative appendectomy and receiver operating characteristic(ROC) curve of the modified Alvarado and RIPASA scoring systems were derived using SPSS statistical software.RESULTS: A total of 136 patients were included in this study according to our criteria. The cut-off threshold point of the modif ied Alvarado score was set at 7.0, which yielded a sensitivity of 82.8% and a specif icity of 56%. The PPV was 89.3% and the NPV was 42.4%. The cut-off threshold point of the RIPASA score was set at 7.5, which yielded a 94.5% sensitivity and an 88% specif icity. The PPV was 97.2% and the NPV was 78.5%. The predicted negative appendectomy rates were 10.7% and 2.2% for the modif ied Alvarado and RIPASA scoring systems, respectively. The negative appendectomy rate decreased significantly, from 18.4% to 10.7% for the modified Alvarado, and to 2.2% for the RIPASA scoring system, which was a signif icant difference(P<0.001) for both scoring systems.CONCLUSION: Based on the results of this study, the RIPASA score is a simple scoring system with better sensitivity and specif icity than the modif ied Alvarado scoring system in Asian populations. It consists of 14 clinical parameters that can be obtained from a good patient history, clinical examination and laboratory investigations. The RIPASA scoring system is more accurate and specific than the modif ied Alvarado scoring system for Kuwait population.

Alvarado, Eskelinen, Ohhmann and Raja Isteri Pengiran Anak Saleha Appendicitis scores for diagnosis of acute appendicitis

AIM:To assess the reliability and practical applicability of the widely used Alvarado,Eskelinen,Ohhmann and Raja Isteri Pengiran Anak Saleha Appendicitis(RIPASA)scoring systems in patients with suspected acute appendicitis.METHODS:Patients admitted to our tertiary center due to suspected acute appendicitis constituted the study group.Patients were divided into two groups.appendicitis group(Group A)consisted of patients who underwent appendectomy and were histopathologically diagnosed with acute appendicitis,and non-appendicitis group(Group N-A)consisted of patients who underwent negative appendectomy and were diagnosed with pathologies other than appendicitis and patients that were followed non-operatively.The operative findings for the patients,the additional analyses from follow up of the patients and the results of those analyses were recorded using the follow-up forms.RESULTS:One hundred and thirteen patients with suspected acute appendicitis were included in the study.Of the 113 patients(62 males,51 females),the mean age was 30.2±10.1(range 18-67)years.Of the 113patients,94 patients underwent surgery,while the rest were followed non-operatively.Of the 94 patients,77patients were histopathologically diagnosed with acute appendicitis.Our study showed a sensitivity level of81%for the Alvarado system when a cut-off value of 6.5was used,a sensitivity level of 83.1%for the Ohmann system when a cut-off value of 13.75 was used,a sensitivity level of 80.5%for the Eskelinen system when a cut-off value of 63.72 was used,and a sensitivity level of 83.1%for the RIPASA system when a cut-off value of 10.25 was used.CONCLUSION:The Ohmann and RIPASA scoring systems had the highest specificity for the diagnosis of acute appendicitis.

Can fruit seeds and undigested plant residuals cause acute appendicitis

Objective:To investigate the relation between fruit seeds,plants residuals and appendicitis. Methods:Among cases that underwent appendectomy,the appendicitis cases having fruit seeds and undigested plant residuals in their etiology were examined retrospectively.Also, histopathological features,age,sex,and parameters of morbidity and mortality were used. Results:Fruit seed was found in one case(0.05%) with presence of pus in appendix lumen, undigested plant residuals in 7 cases(0.35%).It was determined that there were appendix inflammation in 2 of the plant residuals cases,while there were obstruction and lymphoid hyperplasia in the appendix lumen of 5 cases.No mortality was observed.Conclusions:The ratio of acute appendicitis caused by plants is minimal among all appendectomised patients, but avoidence of eating undigested fruit seeds and chewing plants well may help to prevent appendicitis.

New parameter in diagnosis of acute appendicitis:Platelet distribution width

AIM:To investigate the diagnostic accuracy of the mean platelet volume and platelet distribution width in acute appendicitis.METHODS:This retrospective,case-controlled study compared 295 patients with acute appendicitis(Group?Ⅰ),100 patients with other intra-abdominal infections(GroupⅡ),and 100 healthy individuals(GroupⅢ)between January 2012 and January 2013.The age,gender,and white blood cell count,neutrophil percentage,mean platelet volume,and platelet distribution width values from blood samples were compared among the groups.Statistical analyses were performed using SPSS for Windows 21.0 software.In addition,the sensitivity,specificity,positive and negative predictive values and likelihood ratios,and diagnostic accuracy were calculated.RESULTS:The mean ages of patients were 29.9±12.0years for Group?Ⅰ,31.5±14.0 years for GroupⅡ,and30.4±13.0 years for GroupⅢ.Demographic features such as age and gender were not significantly different among the groups.White blood cell count,neutrophil percentage and platelet distribution width were significantly higher in Group?Ⅰ?compared to groupsⅡandⅢ(P<0.05).Diagnostically,the sensitivity,specificity and diagnostic accuracy were 73.1%,94.0%,and 78%for white blood cell count,70.0%,96.0%,and 76.0%for neutrophil percentage,29.5%,49.0%,and 34.0%for mean platelet volume,and 97.1%,93.0%,and 96.0%for platelet distribution width,respectively.The highest diagnostic accuracy detected was for platelet distribution width between Group?Ⅰ?and GroupⅢ(P<0.01).CONCLUSION:Platelet distribution width analysis can be used for diagnosis of acute appendicitis without requiring additional tests,thus reducing the cost and loss of time.