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.

Usefulness of the Pediatric Appendicitis Score and Neutrophil to Lymphocyte Ratio for Assessing the Complicated Appendicitis in Children

Introduction: Acute appendicitis (AA) is a common surgical disease which occurs in almost all age groups, and especially in childhood. Acute appendicitis is one of the most common causes of acute abdomen. The lifetime occurrence of this disease is approximately 7%, with perforation rate of up to 20%. In spite of the well-known classical symptoms and clinical findings of acute appendicitis, early diagnosis can be sometimes challenging. For the treatment of simple appendicitis (SA) in children, the effectiveness of antibiotic treatment has been reported. We aimed to determine predictive value of combination NLR and PAS in pediatric patients with clinical suspicion of acute appendicitis and complicated appendicitis Methods: Our study was performed on 480 children admitted for suspected acute appendicitis and underwent appendectomy at the MNCMCH, Ulaanbaatar Mongolia, between May 2019 and December 2019. White blood count (WBC), Neutrophil, NLR and PAS were compared between groups. Results: The sensitivity, specificity, PPV, NPV of PAS + NLR for differentiating complicated and noncomplicated appendicitis were 86.8%, 89.4%, 92.1% and 76% respectively. The sensitivity, specificity, PPV, NPV of PAS + NLR for diagnosis of acute appendicitis were 90.5%, 68.1%, 97.68% and 32.6% respectively. Conclusion: In the era of conservative antibiotic-based management of uncomplicated acute appendicitis, we advocate that combination of NLR and PAS is a useful aid in predicting complicated appendicitis.