Comparative study of imaging features in uncomplicated and complicated acute appendicitis.

BACKGROUND: Acute appendicitis is a common cause of acute abdominal pain necessitating surgical intervention. While the traditional treatment has been urgent appendectomy, recent studies suggest that an antibiotics-first approach can be safe for uncomplicated cases. Classifying appendicitis into uncomplicated and complicated categories is crucial for guiding treatment decisions and predicting patient outcomes. This study aims to evaluate the distinct imaging findings associated with uncomplicated appendicitis and its complicated subtypes-phlegmonous, gangrenous, and perforated appendicitis-to aid in differential diagnosis. METHODS: This retrospective observational study was conducted from January 2014 to December 2023 and included 1,250 patients (492 women, 758 men) who underwent an appendectomy with available pathology results. After excluding 56 patients with normal pathology, 52 with non-appendicitis pathologies, and 48 with inaccessible computed tomography (CT) images, 1,094 patients were analyzed. CT images were evaluated for appendiceal diameter, wall thickness, cecal wall thickness, periappendiceal fat stranding, effusion, lymphadenopathy, intraluminal and free periappendiceal air, mucosal hyperenhancement, and the presence of appendicolith. RESULTS: The diameter of the appendix, along with the presence of periappendiceal air, effusion, and intraluminal appendicolith, were significantly higher in the perforated appendicitis group compared to other groups (p<0.05). Periappendiceal fat stranding, evaluated as a binary variable, did not show significant differences among the groups. Appendiceal wall thickness was higher in the perforated group and lower in the non-perforated gangrenous group compared to the uncomplicated group (p<0.05). No significant correlation was found for mucosal hyperenhancement between the appendicitis subgroups. Intraluminal air, though normal in a healthy appendix, was a specific predictor of complicated appendicitis when combined with other findings. CONCLUSION: This study provides a detailed analysis of distinct imaging findings associated with uncomplicated and complicated appendicitis. Key differentiators such as appendiceal diameter, periappendiceal air, effusion, and intraluminal appendicolith are crucial for accurate diagnosis. The findings highlight the importance of these parameters in distinguishing various types of appendicitis, offering valuable insights for clinical practice. Future prospective studies and advanced imaging techniques are needed to validate these findings and enhance the diagnosis and management of acute appendicitis and its complications.

Nationwide prospective audit for the evaluation of appendicitis risk prediction models in adults: right iliac fossa treatment (RIFT)-Turkey.

BACKGROUND: Appendicitis is the most prevalent surgical emergency. The negative appendicectomy rate and diagnostic uncertainty are important concerns. This study aimed to assess the effectiveness of current appendicitis risk prediction models in patients with acute right iliac fossa pain. METHODS: A nationwide prospective observational study was conducted, including all consecutive adult patients who presented with right iliac fossa pain. Diagnostic, clinical and negative appendicectomy rate data were recorded. The Alvarado score, Appendicitis Inflammatory Response (AIR), Raja Isteri Pengiran Anak Saleha Appendicitis (RIPASA) and Adult Appendicitis Score systems were calculated with collected data to classify patients into risk categories. Diagnostic value and categorization performance were evaluated, with use of risk category-based metrics including 'true positive rate' (percentage of appendicitis patients in the highest risk category), 'failure rate' (percentage of patients with appendicitis in the lowest risk category) and 'categorization resolution' (true positive rate/failure rate). RESULTS: A total of 3358 patients from 84 centres were included. Female patients were less likely to undergo surgery than men (71.5% versus 82.5% respectively; relative risk 0.866, 95% c.i. 0.834 to 0.901, P < 0.001); with a three-fold higher negative appendicectomy rate (11.3% versus 4.1% respectively; relative risk 2.744, 95% c.i. 2.047 to 3.677, P < 0.001). Ultrasonography was utilized in 56.8% and computed tomography in 75.2% of all patients. The Adult Appendicitis Score had the best diagnostic performance for the whole population; however, only RIPASA was significant in men. All scoring systems were successful in females patients, but Adult Appendicitis Score had the highest area under the receiver operating characteristic curve value. The RIPASA and the Adult Appendicitis Score had the best categorization resolution values, complemented by their exceedingly low failure rates in both male and female patients. Alvarado and AIR had extremely high failure rates in men. CONCLUSION: The negative appendicectomy rate was low overall, but women had an almost three-fold higher negative appendicectomy rate despite lower likelihood to undergo surgery. The overuse of imaging tests, best exemplified by the 75.2% frequency of patients undergoing computed tomography, may lead to increased costs. Risk-scoring systems such as RIPASA and Adult Appendicitis Score appear to be superior to Alvarado and AIR.

Effect of peritoneal and wound lavage with super-oxidized solution on surgical-site infection after open appendicectomy in perforated appendicitis (PLaSSo): randomized clinical trial.

BACKGROUND: Surgical-site infection following open appendicectomy for perforated appendicitis increases length of hospital stay and treatment costs while compromising patients' quality of life. Data from randomized clinical trials (RCTs) evaluating the role of super-oxidized solution in perforated appendicitis are lacking. The study objective was to determine the effect of peritoneal and wound lavage with super-oxidized solution in reducing risk of surgical-site infection following open appendicectomy for perforated appendicitis. METHODS: In this multicentre RCT conducted between September 2020 and March 2022, patients aged 13 years and older with perforated appendicitis undergoing open appendicectomy were randomly assigned to receive peritoneal and wound lavage with either super-oxidized solution or normal saline. The primary outcome was surgical-site infection within 30 days after surgery. Randomization was computer-generated, with allocation concealment by opaque, sequentially numbered, sealed envelope. The patients, surgeons, outcome assessors and statisticians performing the analysis were blinded to treatment assigned. RESULTS: A total of 102 consecutive patients (51 in the super-oxidized solution group and 51 in the normal saline group) were randomized and included in the intention-to-treat analysis. The super-oxidized solution group showed a significant reduction in overall surgical-site infection (8 (15.6%) versus 19 (37.2%); relative risk (RR) 0.42; 95% c.i. 0.20 to 0.87; P = 0.014), and superficial surgical-site infection (5 (9.8%) versus 18 (35.3%); RR 0.28; 95% c.i. 0.11 to 0.69; P = 0.002), with a number-needed-to-treat of four patients. There were no adverse events in either group. CONCLUSIONS: Peritoneal and wound lavage with super-oxidized solution is superior to normal saline in preventing surgical-site infection after open appendicectomy for perforated appendicitis. TRIAL REGISTRATION: ClinicalTrial.gov Identifier: NCT04512196.

Appendicitis in children: correlation between the surgical and histological diagnosis.

PURPOSE: Study was designed in order to evaluate the discrepancies between surgical and histological diagnosis in pediatric acute appendicitis (AA) and to compare the outcomes of laparoscopic (LA) and open appendectomies (OA). METHODS: In a retrospective observational cohort, AA patients were included under 18 years of age, operated between 2011 and 2020. Surgical diagnosis was defined by the operating surgeon. The histological findings were classified as uncomplicated and complicated AA. The LOS and complications were also statistically analyzed. RESULTS: Altogether, 1444 patients were included. Significant strong correlation and a moderate to substantial agreement were found between the surgeon's and the histopathological findings in all appendectomy cases (weighted kappa value in OA: 0.633, LA: 0.639, total sample: 0.637). If the surgeon's diagnosis was less severe than the pathologist's, the LOS was 4 (3;7) days, whereas if the surgical diagnosis was correct, the LOS was 3 (3;5) days (p < 0.0001). CONCLUSIONS: In contrary to the literature, our study revealed a strong correlation and moderate agreement between the intraoperative and histopathological findings regarding the severity of AA. Complicated cases are distinctly recognizable during the surgery. In case the surgeon underestimates the severity of AA, the chance of complications is higher. LEVEL OF EVIDENCE: II.

Clinical outcomes of children with COVID-19 and appendicitis: a propensity score matched analysis.

OBJECTIVE: Early in the COVID-19 pandemic, many children with appendicitis and COVID-19 were initially treated non-operatively and later underwent interval appendectomy. Currently, children with both appendicitis and COVID-19 frequently undergo upfront appendectomy. The impact of this return to upfront surgical management on patient outcomes is unknown. This study compared outcomes of pediatric patients with and without COVID-19 infection undergoing appendectomy. STUDY DESIGN: A retrospective cohort study of children < 21y who underwent appendectomy from 3/19/2020 to 7/31/2022 at 50 Pediatric Health Information System children's hospitals was conducted. Children with documented COVID-19 were identified. Exclusions included preoperative ventilator or supplemental oxygen dependence, and missing data. To evaluate COVID-19 positive versus COVID-19 negative patients, we used a propensity score matched on sociodemographics, comorbidities, laparoscopy, perforation, and hospital. Chi-square and Mann-Whitney U tests identified differences between groups in length of stay, postoperative drain placement, 30-day re-admission, and mechanical ventilation requirements. RESULTS: Overall, 51,861 children of median age 11y (IQR: 8-14) underwent appendectomy, of whom 1,440 (2.3%) had COVID-19. Most were male (60.3%), White (72.1%) and non-Hispanic (61.4%). Public insurance was the most common (47.5%). We created a matched cohort of 1,360 COVID-19 positive and 1,360 COVID-19 negative children. Children with COVID-19 had shorter hospitalizations (1d, IQR: 1-4 vs. 2d, IQR: 1-5, p = 0.03), less postoperative peritoneal drain placement (2.4% vs. 4.1%, p = 0.01), and fewer 30-day readmissions (9.0% vs. 11.4%, p = 0.04). However, no difference in incidence or duration of mechanical ventilation (p > 0.05) was detected. CONCLUSIONS: Our findings suggest that upfront appendectomy for children with appendicitis and COVID-19 has similar outcomes compared to children without COVID-19. LEVEL OF EVIDENCE: Level III.

Postoperative recovery in peroral versus intravenous antibiotic treatment following laparoscopic appendectomy for complicated appendicitis: a substudy of a cluster randomized cluster crossover non-inferiority study.

BACKGROUND: Acute appendicitis is the most common cause of abdominal pain requiring surgery, usually managed with laparoscopic appendectomy. In Denmark, the standard postoperative treatment for complicated cases involves intravenous antibiotics. This study compares peroral versus intravenous antibiotics in the context of fast-track surgery and Enhanced Recovery After Surgery (ERAS) protocols. Our objective is to evaluate the impact of peroral versus intravenous antibiotics on patient-reported outcomes following laparoscopic appendectomy for complicated appendicitis. METHODS: This was a sub-study within a broader Danish cluster-randomized non-inferiority trial conducted at Zealand University Hospital, focusing on adult patients undergoing laparoscopic appendectomy for complicated appendicitis. Participants were randomized into two groups: one receiving a three-day course of peroral antibiotics and the other intravenous antibiotics after surgery. Recovery quality was assessed on the third postoperative day using the Quality of Recovery-15 (QoR-15) questionnaire. RESULTS: The study included 54 patients, 23 in the peroral and 31 in the intravenous groups. The peroral group reported significantly better recovery outcomes, with higher QoR-15 scores (mean difference of 12 points, p < 0.001). They also experienced shorter hospital stays, averaging 47 h less than the intravenous group (p < 0.001). No significant differences between the groups were observed in readmissions or severe postoperative complications. CONCLUSIONS: Peroral antibiotic administration after laparoscopic appendectomy for complicated appendicitis significantly improves patient recovery and reduces hospital stay compared to intravenous antibiotics. These results advocate a potential shift towards peroral antibiotic use in postoperative care, aligning with ERAS principles. TRIAL REGISTRATION NUMBER: ClinicalTrials.gov NCT04803422.

Vascular complications during appendectomy: severe adhesion of the appendix to the right iliac artery: a case report.

INTRODUCTION: Appendicitis is a common cause of acute abdomen. Rarely, it may form adhesions to nearby structures, complicating surgeries, especially when involving vascular structures such as the internal iliac artery, potentially causing severe intraoperative hemorrhage. CASE PRESENTATION: A 65-year-old Middle Eastern male presented with abdominal pain and anorexia for 5 days. Examination and imaging confirmed acute appendicitis with complications. Additionally, a large pelvic mass was noted. During surgery, severe bleeding was encountered due to an adhesion between the appendix and the right internal iliac artery, managed by ligating the artery. The patient recovered well and was discharged in stable condition. Histopathology confirmed the diagnosis. CONCLUSION: This case highlights a rare vascular complication of appendectomy due to abnormal adhesions between the appendix and the internal iliac artery, associated with a large pelvic mass. This study emphasizes the need for thorough preoperative evaluation and careful surgical planning in patients with unusual anatomical variations or specific underlying conditions such as neurofibromatosis. Early recognition and strategic management of vascular adhesions are essential to optimize patient outcomes in appendectomies complicated by such rare scenarios.

Predictive model for identification of gangrenous or perforated appendicitis in adults: a multicenter retrospective study.

BACKGROUND: Gangrene and perforation are severe complications of acute appendicitis, associated with a higher mortality rate compared to uncomplicated appendicitis. Accurate preoperative identification of Gangrenous or perforated appendicitis (GPA) is crucial for timely surgical intervention. METHODS: This retrospective multicenter study includes 796 patients who underwent appendectomy. Univariate and multivariate logistic regression analyses are used to develop a nomogram model for predicting GPA based on laboratory tests and computed tomography (CT) findings. The model is validated using an external dataset. RESULTS: Seven independent predictors were included in the nomogram: white blood cell count, lymphocyte count, D-dimer, serum glucose, albumin, maximum outer diameter of the appendix, and presence of appendiceal fecalith. The nomogram achieved good discrimination and calibration in both the training and testing sets. In the training set, the AUC was 0.806 (95%CI: 0.763-0.849), and the sensitivity and specificity were 82.1% and 66.9%, respectively. The Hosmer-Lemeshow test showed good calibration (P = 0.7378). In the testing set, the AUC was 0.799 (95%CI: 0.741-0.856), and the sensitivity and specificity were 70.5% and 75.3%, respectively. Decision curve analysis (DCA) confirmed the clinical utility of the nomogram. CONCLUSION: The laboratory test-CT nomogram model can effectively identify GPA patients, aiding in surgical decision-making and improving patient outcomes.

Association between body composition and incisional surgical site infection after laparoscopic appendectomy for complicated appendicitis.

PURPOSE: Surgical site infection (SSI) is common after laparoscopic appendectomy, resulting in prolonged hospital stay and increased costs. This study examined the relationship between body composition parameters and risk of incisional SSI in patients with complicated appendicitis. METHODS: We included 411 patients who underwent laparoscopic surgery for complicated appendicitis at a single institution between March 2015 and October 2023. Body composition parameters were derived from preoperative computed tomography (CT). A nomogram was constructed based on the independent predictors of incisional SSI. RESULTS: Overall, 45 (10.9%) patients developed incisional SSI. Visceral fat area (VFA) was independently associated with risk of incisional SSI (hazard ratio 1.015, 95% confidence interval 1.010-1.020, P < 0.001). A nomogram integrating VFA and two other independent predictors (diabetes and conversion) demonstrated high discriminative (area under the curve = 0.793) and calibration abilities. CONCLUSIONS: CT-derived VFA could be a valuable predictor of incisional SSI in patients with complicated appendicitis undergoing laparoscopic surgery. A VFA-based nomogram may help in identifying patients at high risk of SSI.

Management and outcomes of acute appendicitis in children with congenital heart disease.

BACKGROUND: Congenital heart disease (CHD) care has evolved during the past decades. Advances in care have contributed to improved survival among CHD patients. Children with CHD are requiring interventions for non-CHD related medical issues that occur in the general pediatric population. METHODS: A retrospective review of the Pediatric Health Information System (PHIS) database from January 1, 2004, to July 31, 2023. Discharges of patients with an admitting/principal diagnosis of appendicitis were evaluated and categorized as CHD or non-CHD. RESULTS: A total of 319,228 patients were identified with 1,25,858(39.4%) female, 1,38,966(43.5%) white, and median age of 11[IQR:8-14] years. 708(0.2%) had CHD with 85(12%) of them having a diagnosis consistent with single-ventricle CHD (SV-CHD). In univariate analysis, CHD patients were more likely to undergo conservative treatment (n = 172(24.2%)vs n = 59,358(18.6%)) and less likely to undergo laparoscopic appendectomy (n = 483(68.2%) vs n = 2,35,324(73.8%))(p < 0.001) compared to non-CHD. After adjustment, CHD patients had increased odds of undergoing open appendectomy compared to non-CHD. CHD patients were more likely to have an ICU admission (OR:8.36(95%CI 6.35-10.00),p < 0.001) and had a 77.6%(95%CI 40.89-123.93) increase in length of stay (LOS) (p < 0.001). CONCLUSION: CHD patients are more likely to have an open appendectomy than non-CHD patients. These findings suggest a distinctive pattern in the care of CHD patients compared to non-CHD. Overall, CHD patients had a more intense level of care with longer LOS and increased ICU admissions. Further work is needed to evaluate drivers of management decisions, the role of conservative treatment with antibiotics alone in the CHD population, and the potential impacts and safety of a laparoscopic approach.

[Diagnostic scales for acute appendicitis in children]. / Diagnosticheskie shkaly ostrogo appenditsita u detei.

Acute appendicitis, a common medical emergency, primarily affects children, and its diagnosis can be challenging. In addition to methods such as abdominal ultrasound, predictive clinical scales are used, such as the Alvarado scale and others, which categorize risk in pediatric patients. Given the lack of consensus on exact criteria, this review seeks to identify and analyze 22 prediction scales used in the diagnosis of acute appendicitis in children. The search was carried out according to the PRISMA guide, resulting in 73 articles selected from a total of 1521, with inclusion criteria focused on the pediatric population and integrated scales. The importance of predictive scales for appendicitis in children is highlighted, which incorporate clinical history, physical examination, laboratory and images to guide surgical intervention decisions. Among the most used worldwide were the Alvarado and Tzanakis scales, PAS and Heidelberg Appendicitis Score (HAS), designed specifically for pediatric patients.

Autocorrelation of daily resting heart rate: A novel metric of postoperative recovery.

PURPOSE: Resting heart rate (RHR) is a sensitive indicator of an individual's physiologic condition. However, its use in clinical practice has been limited due to the wide variation in baseline RHR based on multiple factors, including age, sex, cardiovascular fitness, and comorbidities. The study aims to develop a novel, clinically meaningful metric that is applicable across these conditions, based on day-by-day changes in RHR-the difference in autocorrelation of daily RHR (ACΔ-RHR). We present ACΔ-RHR in the context of monitoring post-discharge recovery for pediatric appendectomy patients. METHODS: Children 3-17 years old who underwent laparoscopic appendectomy for complicated appendicitis from 2019 to 2022 at a tertiary children's hospital wore a Fitbit for twenty-one postoperative days (POD). Patients without complications were included to describe normative recovery. Using RHR on POD 1-3 as the baseline, autocorrelation of daily RHR was calculated (fixed lag = 1) for POD 3-21. Then, daily ACΔ-RHR was determined by subtracting autocorrelation values between the current and previous day. Means and standard deviations were calculated for daily RHR to estimate on which POD ACΔ-RHR stabilized at 0, representing general RHR stability and recovery from surgery for all patients. Subgroup analyses were performed by age (3-10 years old vs 11-17 years old) and sex. RESULTS: Thirty-one patients were included (58.1 % 3-10 years old, 41.9 % female, 67.7 % Hispanic). Whereas the mean daily RHR did not demonstrate clear trends, the mean ACΔ-RHR for the cohort first reached 0 on POD 12 and stabilized on POD 14 (95 % confidence interval: POD [11,17]). Subgroup analysis showed that ACΔ-RHR stabilized on POD 9 for age of 3-10 years, POD 12 for age of 11-17 years, POD 12 for females and POD 10 for males. CONCLUSIONS: The ACΔ-RHR is a promising clinical metric that could enhance post-surgical patient monitoring, such as for children following laparoscopic appendectomy for complicated appendicitis.

No genetic causality between appendectomy and gastrointestinal cancers: a Mendelian randomization study and meta-analysis in European population.

The impact of appendectomy on the risk of gastrointestinal cancers remains unknown. We aimed to systematically estimate the causal relationship between appendectomy and gastrointestinal cancers in the European population using two-sample Mendelian randomization (TSMR) study methods and meta-analysis. As part of the discovery cohort analysis, we identified independent genetic variants strongly associated with appendectomy from the UK Biobank (50,105 cases) to serve as instrumental variables (IVs). Summary-level data for gastrointestinal cancers were obtained from the FinnGen study. As the replication cohort, IVs associated with appendectomy were extracted in the FinnGen study (28,601 cases). The data for gastrointestinal cancers were obtained from the UK Biobank. Finally, meta-analyses were conducted to evaluate the combined causal effects of the MR results. We found no causal relationship between appendectomy and gastrointestinal cancers in both the discovery and replication cohorts. Finally, the meta-analysis revealed no causal association between appendectomy and gastrointestinal cancers. Our findings suggest no causal relationship exists between appendectomy and gastrointestinal cancers in the European population. This genetic evidence supports the conclusion from other observational studies that appendectomy does not affect the risk of gastrointestinal cancers in the European population.

Ruptured Appendiceal Diverticulum Leading to Tubo-Ovarian Abscess in a Non-Sexually Active Woman: A Case Study.

BACKGROUND Pelvic inflammatory diseases and tubo-ovarian abscesses (TOAs) are rarely seen in non-sexually active (NSA) women. While the pathogenesis of TOA remains unclear, its risk factors include ascending infection of the genital tract, gastrointestinal tract translocation, congenital genitourinary anomalies, as well as virulence of the causative agents, with preceding bacteremia and septicemia. CASE REPORT Herein, we present the case of a 25-year-old female patient who was initially diagnosed with ovarian torsion and underwent diagnostic laparoscopy. Her intraoperative findings included bilateral TOAs and adhesions. Owing to this uncommon presentation, further investigation was conducted, including postoperative computed tomography. The results showed a likelihood of a perforated appendix, with a repeat laparoscopy confirming this diagnosis. Appendectomy and drainage were done. The microbial culture from the ovarian abscess revealed Streptococcus constellatus, a commensal organism found in the oral, gastrointestinal, and urogenital flora. This microorganism is rarely isolated as a pathogenic organism in immune-competent populations. Furthermore, the histopathology report of the appendix showed a rare occurrence of chronic active diverticulitis, with perforation and peri-appendicitis. CONCLUSIONS TOA in NSA women should be considered when evaluating differential diagnoses, with the possibility of infection with an atypical organism. Broad-spectrum antibiotics or multidrug therapy should be administered. When suspicion is raised, an imaging study with a broader view to detect the pathology of other organ systems is recommended. Lower abdominal pain in young female patients still poses a diagnostic dilemma and should be investigated; however, when the clinical presentation suggests a gynecological emergency, the time frame can pose challenges.

Clinical management and complications of acute appendicitis in 3 children with SARS-CoV-2 infection: Case report.

RATIONALE: Sporadic cases of acute appendicitis (AA) in children with SARS-CoV-2 infection were still recorded at the end of COVID-19 pandemics. We consider that analyses of clinical courses and outcomes is useful to improve the clinical management of such cases in the setting of a general hospital. PATIENT CONCERNS: Patient #1 was a 14-year-old girl who presented with nausea, right lower quadrant (RLQ) pain, myalgia, ad low-grade fever for 24 hours. Patient #2 was a 7-year-old boy with a 3-day history of abdominal pain, nausea and vomiting, and fever lasting for 4 days. Patient # 3 was a 16-year-old girl RLQ pain, nausea and vomiting, and fever lasting for 7 days. DIAGNOSES: The patients were diagnosed with acute appendicitis (AA) based on the clinical picture, labs and abdominal ultrasound (US) findings. SARS-CoV- 2 infection was diagnosed using rapid antigen test performed at admission. INTERVENTIONS: The patients were started on i.v. Ceftriaxone and Metronidazole, antalgics and i.v. fluids at admission. Appendectomy was performed the day after admission in patients # 1 and #2, and after 48 hours in patient #3. OUTCOMES: Patient #1 had no complications and was discharged on postoperative day (POD) #5. Patient #2 developed a cecal fistula on POD #4 which was treated conservatively with Ertapenem, i.v. fluids, and local placement of colostomy bag. The fistula closed spontaneously on POD #12. He was discharged on POD #17. Patient #3 developed a postoperative abscess on POD # 6 and required laparoscopic surgical drainage of the abscess. She was discharged after another 6 days (POD #12). No patient required ICU admission, steroids, or supplemental O2 use during their hospitalization. There were no late complications or readmissions in these patients. LESSONS: We consider that AA in these SARS-CoV-2 positive children had a similar course with SARS-CoV-2 negative cases. Compliance to previously established COVID-19 protocols was useful to improve the outcome. The parents should bring the sick child early to the hospital in order to avoid complications related to delayed presentation and not to SARS-CoV-2 infection itself.

Chronic appendicitis misdiagnosed as a periappendiceal orifice polyp: a case report.

BACKGROUND: Unlike acute appendicitis, chronic appendicitis is characterized by nonspecific abdominal pain and intermittent course. This may lead to late diagnosis or misdiagnosis, with the possibility of serious complications. CASE REPORT: A male patient of Arab origin aged 55 years had a 2-year history of recurrent episodes of mild pain in the right lower quadrant of the abdomen. The episodes were associated with nausea, chills, and abdominal bloating but no vomiting, rectal bleeding, or weight loss. On examination, the patient showed soft and lax abdomen with mild tenderness in the right lower quadrant, with no organomegaly or abdominal masses. Laboratory findings showed normal complete blood count and C-reactive protein. The patient underwent colonoscopy to rule out malignancy, which showed appendiceal orifice polyp that required resection. The computed tomography scan showed an enlarged appendix with multiple intraluminal dense appendicoliths. The largest stone at the appendiceal orifice measured 1.5 cm × 0.9 cm and was partially protruding within the cecal lumen. The diagnosis of chronic appendicitis was confirmed. The patient underwent appendectomy and was asymptomatic a few days after discharge. CONCLUSIONS: We are reporting a patient with chronic appendicitis presented with multiple appendicoliths. The patient was initially misdiagnosed as periappendiceal orifice polyp. The current finding highlights the importance of imaging, especially computed tomography in confirming the diagnosis in patients with atypical appendicitis presentation.

[A Case of Low-Grade Appendiceal Mucinous Neoplasm-A Complex Preoperative Diagnosis].

A 63-year-old woman was admitted to our hospital with suspected appendicitis. Abdominal CT revealed an enlarged appendix, and findings consistent with some small nodules. She was diagnosed with appendicitis and successfully treated with antibiotics. Contrast-enhanced CT performed 2 months after discharge revealed a reduction in small nodules, and tumor markers were not elevated. Therefore, we concluded that this case was unlikely to be an appendiceal tumor. Interval appendectomy was performed laparoscopically, and histopathological analysis revealed a low-grade appendiceal mucinous neoplasm(LAMN). Herein, we present this case and review the relevant literature.

The nexus between appendicitis and chronic inflammatory bowel diseases: Unraveling an intriguing association.

Appendicitis is 1 of the most frequent diseases worldwide. In general, it is treated with appendectomy, which, in almost all cases, leads to the healing of the disease and averts acute complications. However, only limited data regarding long-term sequalae, including inflammatory bowel diseases following appendicitis are available. We therefore investigated the association between appendicitis and both Crohn disease (CD) and ulcerative colitis (UC). The present study included 23,991 patients with a history of appendicitis and 23,991 that did not have such a history. Patients were identified within the Disease Analyzer (IQVIA) database in Germany between 2010 and 2020. After a follow-up period of up to 10 years, 0.74% of patients with a history of appendicitis and 0.45% of those in the nonappendicitis cohort were diagnosed with CD (P < .001). Our regression analysis revealed a robust and statistically significant association between appendicitis and the incidence of CD in the entire study population (Hazard ratio: 1.82; 95% confidence interval [CI]: 1.31-2.53). Importantly, this association remained largely consistent across all age groups and both genders. In contrast, no statistically significant link was observed between appendicitis and the subsequent development of UC (Hazard ratio: 1.24; 95% CI: 0.90-1.71). The present study presents novel data from a large cohort of outpatients in Germany, providing strong evidence for an association between appendicitis and the development of CD (but not UC). These findings contribute to the existing body of literature and may facilitate the recognition of appendicitis as a risk factor for the development of chronic inflammatory bowel diseases.