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 te-chnology, 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.

Pseudomyxoma peritonei peritonitis.

Pseudomyxoma peritonei (PMP) is a rare neoplastic condition characterised by gelatinous ascites, which generally arise from mucin-producing appendiceal tumours. Presentation is variable but requires prompt recognition to ensure appropriate specialist management due to risk of malignancy.A male in his 40s presented with a 1-day history of sudden onset, non-migratory abdominal pain, worse in the right iliac fossa. He had no significant medical history nor known drug allergies. Examination revealed right iliac fossa peritonism and blood tests revealed raised inflammatory markers. CT scan showed a right-sided abdominal collection. Intraoperatively, a diagnostic laparoscopy was performed, which revealed extensive mucin in the abdominal cavity. This was washed out and a laparoscopic appendectomy was performed; histopathology confirmed PMP from the ruptured appendix.

Perforated appendicitis within a spigelian hernia.

A woman in her 90s presented to the emergency department with new onset pain in a long standing right spigelian hernia. She was febrile and mildly hypotensive. CT scan demonstrated a hernia containing small and large bowel with significant fat stranding and thus proceeded to operative management via an open appendicectomy and suture repair of the hernia. There are few similar cases in the literature, with the predominance being suture repair, a roughly even split between open and laparoscopic approaches.

Appendiceal neoplasms in Saudi Arabia: prevalence and clinicopathological profile.

BACKGROUND: The appendix is a small organ with no particular known function. Primary appendiceal neoplasms (ANs) are rare. While the prevalence is increasing worldwide over the past two decades, no apparent increase in the prevalence of ANs has been reported in the Arabian Gulf States. Recently, a significant decline in the age at diagnosis of some types of ANs has been reported worldwide, with a female predominance. OBJECTIVES: Evaluate the prevalence and clinicopathological characteristics of ANs within our institution in Saudi Arabia and compare them to limited existing studies from different regions as well as the Arabian Gulf States. DESIGN: Retrospective cohort. SETTING: Tertiary care center in Riyadh. PATIENTS AND METHODS: All patients who underwent appendectomy and had the appendix submitted for histopathological evaluation between May 2015 and June 2020 were included to allow for a follow-up of 5 years or more at the time of data collection. MAIN OUTCOME MEASURES: Demographics, clinical presentations, surgical interventions, histopathological findings, complications, and recurrence rates. SAMPLE SIZE: 25 AN patients. RESULTS: Of 1110 patients, 25 had ANs (13 female and 12 male participants) with a mean (standard deviation) age of 54.6 (14.1) years. Only 40% presented with acute appendicitis, 64% had comorbidities, and less than 50% underwent laparoscopic appendectomy. Histopathologically, 72% were low-grade appendiceal mucinous neoplasms (LAMNs). Complications were minimal grades (Clavien-Dindo classification), with 80% experiencing none. The mean hospital stay was 9.96 days. Local recurrence occurred in 8% of cases, and distant metastasis was documented in one adenocarcinoma case. However, the 5-year overall and disease-free survival rates were 88% and 80%, respectively. CONCLUSIONS: The incidence of ANs is increasing in Saudi Arabia with the higher prevalence of LAMNs. The pathological examination of the resected appendix played a pivotal role in the diagnosis of ANs. LIMITATIONS: Data collected retrospectively, a single institution, and a small population.

Daytime versus nighttime appendectomy in term of complications and clinical outcomes: a meta-analysis.

BACKGROUND: Appendicitis is one of the most common acute surgical conditions globally. However, the association between nighttime appendectomy and patients' morbidity and mortality is unclear. This study aims to compare outcomes following nighttime versus daytime appendectomy. METHODS: The PubMed, Embase, Cochrane Library, and Web of Science databases up to March 26, 2024 (updated on July 1, 2024) were searched. The primary outcomes were postoperative complications and mortality. Secondary outcomes included intraoperative complications, reoperation, readmission, conversion to laparotomy, hospital stay and operation time. Mean difference (MD) or odds ratios (OR) and 95% confidence intervals were calculated. RESULTS: Fifteen studies totaling 33,596 patients were included. There were no differences between nighttime and daytime appendectomy for rates of overall postoperative complications (OR 0.93, 95% CI 0.87, 1.00, 14 studies), mortality (OR 1.70, 95% CI 0.37, 7.88, 7 studies), intraoperative complications (OR 0.88, 95% CI 0.08, 9.86; 2 studies), reoperation (OR 0.39, 95% CI 0.06, 2.55; 3 studies) and readmission (OR 0.86, 95% CI 0.65, 1.13; I2 = 0%, 5 studies). However, the conversion to laparotomy risks (OR 1.92, 95% CI 1.12, 3.29; 6 studies) among patients who underwent appendectomy during nighttime was significantly elevated compared to daytime. CONCLUSIONS: There was no increased risk or difference in postoperative mortality and complication rates associated with nighttime compared with daytime appendectomy. However, future studies should assess the reasons for higher conversion rates during the night.

Prognostic value of 24-hour cultivation of peritoneal fluid to distinguish complicated from uncomplicated acute appendicitis: a prospective cohort study.

BACKGROUND: The distinction between complicated and uncomplicated acute appendicitis (AA) is important as it guides postoperative antibiotic treatment. A diagnosis based on intraoperative findings is imprecise and standard cultivation of peritoneal fluid is generally time-consuming with little clinical benefit. The aim of this study was to examine if cultivation of peritoneal fluid in acute appendicitis could reliably detect bacteria within 24 h. METHODS: Patients older than 18 years undergoing laparoscopic appendectomy were prospectively enrolled at two surgical departments after informed consent was obtained. Periappendicular fluid was collected prior to appendectomy and sent for cultivation. Sensitivity, specificity and positive and negative predictive values were calculated with 95% confidence intervals (CIs) using 72-hour cultivation results as the gold standard. Patients with complicated AA as determined by the surgeon, received a three-day course of oral antibiotics. Postoperative infectious complications within 30 days after surgery were registered. RESULTS: From July 2020 to January 2021, 101 patients were included. The intraoperative diagnosis was complicated AA in 34 cases. Of these patients, six (17.6%) had bacteria cultured within 24 h after surgery, leading to a sensitivity of 60% and a specificity of 100%. The positive and negative predictive values were 1.00 and 0.96, respectively. Seven patients developed a postoperative infection (five superficial wound infections and two intra-abdominal abscess). In all cases with a positive cultivation result, the intraoperative diagnosis was complicated appendicitis and a postoperative course of antibiotics prescribed. CONCLUSION: Twenty-four-hour cultivation of the peritoneal fluid in acute appendicitis is a valid indicator for peritoneal bacterial contamination. Randomized studies are necessary to determine if this approach is suitable for targeting postoperative antibiotic treatment as a means to prevent overtreatment without increasing the risk of infectious complications.

Risk factors for developing intra-abdominal abscess following appendicectomy for acute appendicitis: a retrospective cohort study.

BACKGROUND: Laparoscopic appendicectomy is commonly performed in Australia for treatment of acute appendicitis. Intra-abdominal abscess (IAA) is a potential complication following appendicectomy for acute appendicitis. Risk factors for developing post-operative IAA remain controversial and poorly defined. Laparoscopic washout may be performed for patients who develop complication(s) including IAA. The aim of this study was to define risk factors for both the development of IAA and identify patients who may require laparoscopic washout following appendicectomy. METHODS: Data were obtained from 423 patients who underwent laparoscopic appendicectomy over a five-year period (2012-2017). Clinical (fever, haemodynamics, examination findings), biochemical (white cell count, neutrophil count, C-reactive protein, bilirubin, albumin), radiological (CT free fluid), and operative factors (inflammation, suppuration, free-fluid, perforation, histopathology) collected in the pre-, peri-, and post-operative period(s) were analysed. RESULTS: 23 (5.4%) patients developed post-operative IAA. Duration of intravenous antibiotics was significantly longer in patients who developed IAA and in those who required laparoscopic washout (p < 0.0001). C-reactive protein (CRP) on admission (p < 0.05) and appendiceal perforation (p = 0.0005) were significantly higher in patients who either developed IAA or needed laparoscopic washout. No clinical or radiological finding predicted either the development of IAA or need for laparoscopic washout. CONCLUSION: Elevated CRP on admission may predict the development of post-operative IAA formation or the need for laparoscopic washout post-appendicectomy. Prolonged post-operative antibiotic use appears independent of the development of IAA as well as the need for laparoscopic washout. These data highlight the need for clear guidelines on peri-operative antibiotic use following appendicectomy.

Effect of peritoneal drainage on the prognosis following appendectomy in pediatric patients with appendicitis: a retrospective study based on appendicitis grade.

BACKGROUND: This study aimed to assess the impact of peritoneal drainage and its type on prognosis, encompassing postoperative recovery and complications, in pediatric patients (≤ 16 years old) following appendectomy based on the grade of appendicitis. METHODS: In this retrospective study, we analyzed pediatric patients (≤ 16 years old) with appendicitis who met the inclusion and exclusion criteria in our center from January 2017 to January 2024 and classified them into grade I-V based on the grade of appendicitis, with V representing the most serious cases. The patients were grouped according to drainage status and type. The main clinical outcomes included postoperative rehabilitation indexes such as time to resume a soft diet, time to remove the drain, duration of postoperative antibiotic use and length of hospitalization (LOH), as well as postoperative complications including intra-abdominal abscess (IAA), ileus and wound infection (WI), and readmission within 30 days after surgery. RESULTS: A total of 385 pediatric patients with appendicitis were included in the study and divided into No-drainage (ND) group (n = 74), Passive drainage (PD) group (n = 246) and Active drainage (AD) group (n = 65) according to drainage status and type. Compared to the other two groups, the ND group had a significantly shorter time to resume a soft diet, duration of postoperative antibiotic use and LOH, and these differences were statistically significant. Similar findings were observed in grade I patients too (P < 0.05). In all cases examined here, the AD group had a significantly shorter time for drain removal compared to the PD group (3.04 [1-12] vs 2.74 [1-15], P = 0.049); this difference was also evident among grade I patients (2.80 [1-6] vs 2.47 [1-9], P = 0.019). Furthermore, within the same grade, only in grade IV did the AD group exhibit a shorter duration of postoperative antibiotic use compared to the PD group (4.75 [4-5] vs 8.33 [5-15], P = 0.009). Additionally, the LOH in the AD group was longer than that in the PD group (8.00 [4-13] vs 4.75 [4-5], P = 0.025). Among all cases, the ND group exhibited significantly lower incidences of overall complications and WI compared to the other two groups (P < 0.05). Additionally, the incidence of IAA in the ND group was significantly lower than that in the PD group (0% vs 5.3%, P = 0.008 < 0.0167). Furthermore, although there were no statistically significant differences in the incidence of overall complications, IAA, ileus, and WI between the PD and AD groups during grade ≥ II analysis (P > 0.05), a higher readmission rate within 30 days was observed in the PD group compared to the AD group; however, these differences were not statistically significant (P > 0.05). Moreover, multivariate analysis revealed that a higher grade of appendicitis was associated with an increased risk of overall complications and IAA as well as a longer duration of postoperative antibiotic use and LOH. CONCLUSION: The appendicitis grade is a crucial indicator for predicting postoperative IAA and LOH. In patients with grade I appendicitis, peritoneal drainage, even if active drainage, is not recommended; For patients with grade ≥ II appendicitis, active drainage may be more effective than passive drainage in reducing the duration of postoperative antibiotic use and LOH.

Construction of a laparoscopic appendectomy model.

INTRODUCTION: Appendectomy is the standard treatment for appendicitis, with the laparoscopic technique offering benefits like lower infection rates and quicker recovery. However, residents often have their first practical experience with the procedure on real patients, increasing surgical risks. In this context, medical simulation emerges as a crucial methodology, allowing professionals to experience a variety of scenarios while preventing harm to patients. The objective of this study is to describe the production of an "ex-vivo" simulation model for laparoscopic appendectomy. METHODOLOGY: Cold ceramic structures were used to manually shape the anatomical model of the appendix, ensuring its rigidity. On this model, we poured materials to create a flexible mold using acetic silicone. Once the mold was made, we filled it with thermo-moldable styrene polymer rubber, along with dye, and fused it at a specific temperature. RESULTS: This process resulted in the manufacture of a piece that simulates the appendix, being tear-resistant and suturable, faithfully replicating the structure and characteristics of a human organ. The low weight of the materials facilitates transport, allowing them to be reproduced and used in various situations, from training in hospital settings to universities. The model is applicable in didactic simulations with medical students, residents, and surgeons. Its ease of production and low cost contribute to the practices being repeatable, ensuring a better development of surgical skills. CONCLUSION: This work not only contributes to the advancement of medical simulation but also highlights the importance of innovative and collaborative solutions in improving medical education and promoting patient safety.

Appendicolith classification: physical and chemical properties of appendicoliths in patients with CT diagnosed acute appendicitis - a prospective cohort study.

OBJECTIVE: Appendicoliths are associated with a more complicated course of acute appendicitis and failure of non-operative treatment. We aimed to update the appendicolith classification originally described in 1966 and to assess the association of appendicolith characteristics with appendicitis severity. DESIGN: This prospective predefined MAPPAC-trial (ClinicalTrials.gov NCT03257423) substudy included patients with CT diagnosed appendicitis presenting with an appendicolith. CT visible appendicoliths were harvested at surgery, measured and characterised by morphological examination complemented with micro-CT and micro-X-ray fluorescence spectroscopy. Patients were categorised into two groups: appendicolith appendicitis without other complications and appendicolith appendicitis with complications (appendiceal gangrene, perforation and/or abscess). The association of appendicolith classification and characteristics with appendicitis severity was evaluated. RESULTS: Of 78 patients with a CT appendicolith, 41 appendicoliths were collected and classified based on the degree of hardness into three classes. The hardest appendicoliths (class 3) were less common (19.5%) presenting with a stone-hard outer layer and concentrically layered inner structure around a core. The layered inner structure was also observed in class 2 appendicoliths, but was absent in soft, class 1 appendicoliths. Appendicolith hardness or measures (maximum length, diameter and weight) were not associated with appendicitis severity. The spatial distribution of the main inorganic elements of calcium and phosphorus varied within most appendicoliths. CONCLUSION: This updated classification confirms categorisation of CT visible appendicoliths into three classes based on their physical and chemical characteristics. The data on clinical and aetiopathological characteristics of appendicoliths is scarce and using this systematic classification would add to this understanding.

Long Round-Trip Time Delay Effects on Performance of a Simulated Appendectomy Task.

INTRODUCTION: No current astronauts have surgical training, and medical capabilities for future missions do not account for it. We sought to determine the effect of communication delays and text-based communication on emergency medicine physician (EMP) performance of a simulated surgical procedure and the ideal training paradigm for remote surgery.METHODS: In this study, 12 EMPs performed an appendectomy on a virtual reality laparoscopic simulator after tutorial. EMPs were randomized into two groups: one (bedside) group performing with bedside directing from a surgeon and the second (remote) group performing with text-based communications relayed to the surgeon after a 210-s time delay. Both groups performed a second simulated surgery 7 mo later with 240-s delay. Collected data included time to completion, number of movements, path length, economy of motion, percentage of time with appropriate camera positioning, texts sent, and major complications.RESULTS: The remote group took significantly longer to complete the task, used more total movements, had longer path length, and had significantly worse economy of motion during the initial trial. At the 7-mo simulation, there were no significant differences between the two groups. There was a nonsignificant increase in critical errors in the remote group at follow-up (50% vs. 20% of trials).DISCUSSION: EMPs are technically able to perform a surgical operation with delayed just-in-time telementoring guidance via text-based communication. However, the ideal paradigm for training non-surgeons to perform surgical operations is unclear but is likely real-time bedside training rather than remote training.Kamine TH, Siu M, Stegemann S, Formanek A, Levin D. Long round-trip time delay effects on performance of a simulated appendectomy task. Aerosp Med Hum Perform. 2024; 95(9):703-708.

Outcomes Following Surgical and Nonsurgical Treatment for Uncomplicated Appendicitis in Older Adults.

Importance: The optimal treatment of acute uncomplicated appendicitis in older adults with frailty is not defined. Objective: To examine outcomes associated with treatment strategies for acute uncomplicated appendicitis in older adults with or without frailty. Design, Setting, and Participants: This retrospective cohort study used National Inpatient Sample data from adults 65 years or older with a diagnosis of uncomplicated appendicitis from January 1, 2016, to December 31, 2018. Data were analyzed from July to November 2023. The National Inpatient Sample database approximates a 20% stratified sample of all inpatient hospital discharges in the US. Exposures: Study patients were categorized into 3 groups: nonoperative management, immediate operation, and delayed operation. Main Outcomes and Measures: Clinical outcomes, including hospital complications and in-hospital mortality, were assessed among older adults with and without frailty, identified using an adapted claims-based frailty index. Results: A total of 24 320 patients were identified (median [IQR] age, 72 [68-79] years; 50.9% female). Of those, 7290 (30.0%) were categorized as having frailty. Overall, in-hospital mortality was 1.4%, and the incidence of complications was 37.3%. In patients with frailty, multivariable analysis showed both nonoperative management (odds ratio [OR], 2.89; 95% CI, 1.40-5.98; P < .001) and delayed appendectomy (OR, 3.80; 95% CI, 1.72-8.43; P < .001) were associated with increased in-hospital mortality compared with immediate appendectomy. In patients without frailty, immediate appendectomy was associated with increased hospital complications compared with nonoperative management (OR, 0.77; 95% CI, 0.64-0.94; P = .009) and lower hospital complications compared with delayed appendectomy (OR, 2.05; 95% CI, 1.41-3.00; P < .001). Conclusions and Relevance: In this cohort study of older adults with uncomplicated appendicitis, outcomes differed among management strategies based on frailty status. Routine frailty assessments incorporated in the care of older adult patients may help guide discussions for shared decision-making.

Effect of Intraspinal Anesthesia on Postoperative Recovery in Elderly Patients with Acute Appendicitis: A Retrospective Study.

AIM: Acute appendicitis is a common disease in the elderly. Exploring a suitable anesthesia method is crucial in promoting postoperative recovery in elderly patients. Therefore, this study aimed to investigate the clinical effect of intraspinal anesthesia in elderly patients with appendicitis. METHODS: This study included the clinical data of 217 elderly patients with acute appendicitis who underwent laparoscopic appendectomy (LA) at Tianjin Hospital of Tianjin University from January 2022 to January 2023. After excluding 8 patients who did not meet the inclusion criteria, the data from 209 patients were retrospectively analyzed. Based on the different anesthesia methods, the study participants were divided into a reference group (n = 106) and a study group (n = 103). We compared the heart rate (HR), respiratory rate (RR), systolic blood pressure (SBP), diastolic blood pressure (DBP), blood oxygen saturation (SaO2), operation duration, hospitalization costs, discharge time, postoperative adverse reactions, inflammatory factor levels, Visual Analogue Scale (VAS) score, recovery time of intestinal peristalsis, anal exsufflation time, out-of-bed time, and incidence of postoperative complications between the two experimental groups. RESULTS: We observed that the study group exhibited higher levels of HR, RR, SBP, DBP, and SaO2 compared to the reference group (p < 0.001). However, there was no difference in operation time between the two groups (p > 0.05). The study group showed lower hospitalization cost and shorter discharge time than the reference group (p < 0.001). Similarly, the study group had lower incidence of postoperative adverse reactions than reference group (p < 0.05). There were no significant differences in the levels of C-reactive protein, interleukin-6, and tumor necrosis factor-α between the two groups before and after surgery (p > 0.05). Furthermore, the study group had a lower VAS score compared to the reference group at 3 h, 6 h and 12 h after surgery (p < 0.001). The recovery time of intestinal peristalsis, anal exsufflation time, and out-of-bed time in the study group were substantially shorter than the reference group (p < 0.001). Additionally, there was no difference in the incidence of postoperative complications between the two groups within 1 year after surgery (p < 0.001). CONCLUSIONS: Intraspinal anesthesia, as a safe anesthesia method, can reduce the discharge time of elderly patients with acute appendicitis who underwent LA, and reduce the occurrence of adverse reactions, and is beneficial for postoperative recovery.

[Factors associated with normal leukocyte count and C-reactive protein in adults with acute appendicitis: a retrospective cohort study]. / Faktory, svyazannye s normal'nym kolichestvom leikotsitov i urovnem S-reaktivnogo belka u vzroslykh bol'nykh s ostrym appenditsitom: retrospektivnoe kogortnoe issledovanie.

OBJECTIVE: To identify the factors associated with normal leukocyte count and C-reactive protein (CRP) in adults with acute appendicitis. MATERIAL AND METHODS: A retrospective cohort study included patients aged 18-60 years after surgeries for acute appendicitis. Convenience sampling was used to select medical records, and variables such as age, sex, weight, height, origin, self-medication, diabetes (DM2), high blood pressure (HBP), type of appendicitis, duration of illness, preoperative time, type of appendectomy, operative time, and hospital stay were analyzed. Patients were categorized into those with normal and abnormal inflammatory parameters. The SPSS version 28 software was used for analysis. RESULTS: We included 333 patients; 11.11% ones had normal inflammatory parameters. Both groups had mean age of approximately 33 years. Men comprised 56.76% and 57.43%in both groups, respectively. The abnormal group had shorter mean preoperative time, and catarrhal appendicitis was more common in the normal group. Multivariate analysis revealed that rural origin and self-medication were significantly associated with normal inflammatory parameters. CONCLUSION: The prevalence of normal inflammatory parameters in acute appendicitis patients was 11.11%. Rural origin, self-medication, shorter preoperative time, and catarrhal appendicitis were significantly associated with normal inflammatory parameters in this context.

Low-grade appendiceal mucinous neoplasms: Histomorphological spectrum in a tertiary care hospital.

BACKGROUND: Low-grade appendiceal mucinous neoplasms (LAMNs) are benign non-invasive epithelial proliferations of the appendix. These usually present clinically as mucoceles and these rarely exceed 2 cm in diameter. Lesions confined to the lumen are labelled as LAMN; however those in which mucin spreads outside the peritoneum are labeled as pseudomyxoma peritonei (PMP). AIMS AND OBJECTIVE: A retrospective study was conducted over a period of three years and all cases of appendectomies were studied. Twelve cases of LAMN were identified, which is a diagnostic dilemma for the pathologists and clinicians. RESULTS: LAMN was identified based on the histopathological features. Out of the 12 cases, 9 were classified as LAMN and 3 as appendiceal neoplasm with PMP. There was villous or flat proliferation of epithelial lining, loss lymphoid aggregates, and dissecting mucin within muscularis. CONCLUSION: LAMNs are rare neoplasms of the appendix, with clinical presentation similar to acute appendicitis. Mucinous collections within the appendiceal wall should be extensively searched for mucosal changes and, if found, should prompt a careful search for pushing invasion of LAMNs. A thorough and vigilant gross examination can be of great help. Appendicectomy is the treatment of benign and grossly intact mucinous neoplasm.

Diagnostic value of systemic immune inflammation index in acute appendicitis and complicated appendicitis in pregnant patients.

INTRODUCTION: Acute pain in the right lower quadrant during pregnancy is difficult to approach and acute appendicitis must be excluded. The complication rate in pregnant acute appendicitis increases as a result of delayed diagnosis due to physiological and anatomic changes. The systemic immune inflammatory index (SII), which includes several inflammatory tests, is considered to be a good indicator of acute inflammation. The aim of the present study was to investigate the diagnostic value of SII in the diagnosis of acute appendicitis and complicated appendicitis in pregnant women. MATERIAL-METHOD: This was designed as a retrospective, single-center case-control study. This study was performed in pregnant women over 12 weeks of gestation who were diagnosed with acute appendicitis as indicated by pathology report and met the inclusion criteria. Vital parameters, demographic characteristics, laboratory values, presence of complicated appendicitis, and pathology reports were taken into analysis. RESULTS: The present study was performed with 76 pregnant women, including 38 pregnant women with acute appendicitis and 38 pregnant women with healthy controls. SII had a sensitivity of 82.0% and specificity of 66.7% with a cut-off value of 840.13 in pregnant acute appendicitis cases (AUC: 0.790; 95% CI: 0.686-0.984; p < 0.001) and SII level was significantly higher in complicated appendicitis cases with a sensitivity and specificity of 66.7% and 91.3%, respectively, with a cut-off value of 2301.66 (AUC: 0.812; 95% CI: 0.665-0.958; p = 0.001). CONCLUSION: SII is a cost-effective, rapid, easily calculated, and powerful marker that can be used for the diagnosis of both acute and complicated appendicitis in pregnant patients.

Leaking Ectopic Pregnancy Following In vitro Fertilization with Associated Acute Appendicitis.

BACKGROUND: Ectopic pregnancy associated with appendicitis is rare, with very few cases reported in the literature. It is unclear if appendicitis is coincidentally associated with ectopic pregnancy or a possible risk factor for the development of ectopic pregnancy. Ruptured ectopic pregnancy has also been postulated as a possible risk factor leading to appendicitis because of the probable inflammatory reaction involving the adjacent appendix. METHODS: We present a 34-year-old female who presented with right lower abdominal pain and bleeding per vaginam, three weeks after in-vitro fertilization and embryo transfer. RESULTS: A diagnosis of ectopic pregnancy was made following a positive ß-HCG and empty uterine cavity on pelvic ultrasound scan. Intraoperatively, the appendix was noted to be inflammed and it was removed and confirmed on histology examination as acute appendicitis. CONCLUSION: Ruptured ectopic pregnancy associated with acute appendicitis is rare, with few cases reported in the literature. We recommend an examination for other possible differentials of ruptured ectopic pregnancy like appendicitis during surgery for ectopic pregnancy on the right side.

CONTEXTE: L'association de la grossesse extra-utérine avec l'appendicite est rare, avec très peu de cas rapportés dans la littérature. Il n'est pas clair si l'appendicite est associée de manière fortuite à la grossesse extra-utérine ou si elle constitue un facteur de risque possible pour le développement de celle-ci. On a également postulé que la grossesse extra-utérine rompue pourrait être un facteur de risque conduisant à l'appendicite en raison de la probable réaction inflammatoire impliquant l'appendice adjacent. MÉTHODES: Nous présentons le cas d'une femme de 34 ans qui s'est présentée avec une douleur abdominale basse à droite et des saignements vaginaux, trois semaines après une fécondation in vitro et un transfert d'embryon. RÉSULTATS: Un diagnostic de grossesse extra-utérine a été posé suite à un test de ß-HCG positif et une cavité utérine vide à l'échographie pelvienne. En peropératoire, l'appendice a été noté comme étant inflammé et a été retiré. L'examen histologique a confirmé une appendicite aiguë. CONCLUSION: La grossesse extra-utérine rompue associée à une appendicite aiguë est rare, avec quelques cas rapportés dans la littérature. Nous recommandons un examen pour d'autres diagnostics différentiels possibles de la grossesse extra-utérine rompue, comme l'appendicite, lors de la chirurgie pour grossesse extra-utérine du côté droit. MOTS CLÉS: Grossesse extra-utérine hémorragique, Appendicite, Fécondation in vitro, Laparotomie.

[Appendix ... it's not just appendicitis: neuroendocrine tumors.] / L'appendice... non è solo appendicite: i tumori neuroendocrini.

Well-differentiated neuroendocrine tumors of the appendix (NETs) are rare in pediatric and adolescent age groups. However, they are the most common gastrointestinal epithelial tumor in this age group and the most common malignancy of the appendix in the general population. The classification of these tumors considers factors such as the proliferation index, size of the neoplasm, and the presence of perineural and/or lymphovascular invasion, which can contribute to distant metastases. Preoperative diagnosis is challenging, except in cases where patients exhibit symptoms of carcinoid syndrome or signs of metastatic disease, which are uncommon in pediatric and adolescent patients. For tumors smaller than 1 cm, appendectomy is usually curative, while larger tumors or those at risk of spreading may require right hemicolectomy with lymphadenectomy. We present a case of an adolescent with NET and provide a literature review on the diagnostic and therapeutic approaches that should be considered for this relatively rare condition.Key words. Adolescent age, appendix, neuroendocrine tumors, pediatric age.