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.

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.

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.

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.

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.

[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.

[Right-sided acute appendicitis in situs inversus totalis. Case report]. / Apendicitis aguda del lado derecho en situs inversus totalis. Reporte de caso.

Background: Acute appendicitis is widely recognized as the prevailing abdominal surgical emergency globally, exhibiting an annual incidence ranging from 96.5 to 100 cases per 100,000 adults. Conversely, situs inversus totalis is a rare anatomical anomaly characterized by the complete reversal of the chest and abdominal organs, occurring in approximately 1 out of every 10,000 to 50,000 individuals. Clinical case: 53-year-old female patient who presented to the emergency department with a complaint of diffuse abdominal pain of colic nature that had persisted for 5 days. The patient referred systemic hypertension, pre-diabetes mellitus type 2, and situs inversus as relevant medical history. A laparotomy procedure was conducted, revealing a perforated appendix located in the right hypochondrium. Additionally, the patient exhibited situs inversus totalis, with the colon positioned in its normal anatomical location. Conclusions: Due to the low incidence of situs inversus totalis, in cases similar to the one presented, the utilization of image studies and laboratory studies is imperative for accurate diagnosis. In the face of diagnostic suspicions and inconclusive paraclinical studies, the most effective approach is to pursue surgical examination and intervention, preferably utilizing laparoscopic techniques.

Introducción: la apendicitis aguda es la urgencia quirúrgica abdominal más frecuente en el mundo, con una incidencia anual de 96.5 a 100 casos por 100,000 adultos. Por otra parte, el situs inversus totalis es un trastorno posicional inverso de los órganos torácicos y abdominales con una incidencia de 1 en 10,000 a 50,000 personas. Caso clínico: paciente del sexo femenino de 53 años que se presentó en sala de urgencias refiriendo dolor abdominal difuso tipo cólico de 5 días de evolución. La paciente refirió hipertensión arterial sistémica esencial, prediabetes mellitus tipo 2 y situs inversus. Se realizó intervención quirúrgica (laparotomía) en la que se encontró el apéndice perforado en hipocondrio derecho y situs inversus totalis con colon en posición anatómica normal. Conclusiones: debido a la baja incidencia del situs inversus totalis, el diagnóstico en casos como el presentado representa un reto en el que el uso de estudios de imagen y laboratorio resulta indispensable. Ante la sospecha diagnóstica y estudios paraclínicos con resultados no concluyentes, la mejor estrategia consiste en la exploración y el manejo quirúrgicos, preferentemente laparoscópicos.

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.

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.

Mucocoele of the appendix.

Introduction: Mucocoele of the appendix occurs in 0.2-0.7% of people in the world without any well-defined clinical symptoms. It occurs when there is an accumulation of mucous in the lumen of the appendix. Case Presentation: We present three cases: a 48-year-old male admitted to the emergency room with a one-day history of right iliac fossa pain. Abdominal examination was suggestive of acute appendicitis. The initial abdominal computerised tomography scan was reported as being unremarkable. At surgery, a firm tumour of the appendix was found, and a limited right hemicolectomy was done. Histopathology confirmed a mucocoele of the appendix with borderline mucinous histology.The second case is a 63-year-old man who presented with a one-year history of abdominal distension and weight loss. Previous abdominal ultrasound was suggestive of liver cirrhosis with significant ascitic fluid. Abdominal magnetic resonance imaging found an appendix mucocoele with infiltration of the omentum and scalloping of the liver surface suggestive of pseudomyxoma peritonei. A percutaneous biopsy of the omental mass confirmed metastatic mucinous adenocarcinoma of the appendix.The third case is a 68-year-old man who, during an annual medical check-up, had an incidental finding of a cystic right iliac fossa mass on ultrasound, confirmed on abdominopelvic computerised tomography scan to be an appendix mucocele. He had laparoscopic appendicectomy. The histopathological diagnosis confirmed a mucinous cystadenoma of the appendix. Conclusion: Preoperative diagnosis of appendiceal mucocoele is difficult and commonly discovered intraoperatively. The prognosis is good for the histologically benign type, but it is poor when malignant or peritoneal lesions are present. Funding: None declared.

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.

Culture-based bacterial evaluation of the appendix lumen and antibiotic susceptibility of acute appendicitis in Japan: A single-center retrospective analysis.

The question of whether to perform an appendectomy or conservative treatment for acute appendicitis can differ depending on the facility or surgeon, but antibiotic treatment is administered regardless of whether an appendectomy or conservative treatment is selected. We investigated the contemporary bacteriology for acute appendicitis and evaluated the antibiotic sensitivity of the bacteria that are currently associated with appendicitis. We retrospectively analyzed the bacterial culture results and antibiotic susceptibility of 141 patients who underwent appendicitis surgery, including the identification and antimicrobial susceptibility of the cultured bacteria within the excised appendices. Bacterial cultures were positive in 131 cases (92.9%). The most commonly isolated bacteria were Escherichia coli (90 isolates, 66.7%), followed by Enterococcus species (n = 19, 14.5%), Pseudomonas aeruginosa (n = 18, 13.7%), Streptococcus species (n = 15, 11.5%), and Klebsiella species (n = 8, 6.1%). Eight strains (8.8%) of E coli were extended-spectrum ß-lactamase producers, and ten strains (11.1%) were fluoroquinolone-resistant. Tazobactam/piperacillin and meropenem inhibited the growth of 100% of the major identified bacteria. The patients with appendicoliths had a significantly higher bacterial culture rate. Enterococcus species were frequently isolated from the patients with complicated appendicitis. For the antibiotic treatment of appendicitis, it is essential to understand the patient's microbiological profile and antibiotic susceptibilities. Research from Asian countries such as Japan can enhance our knowledge of regional antibiotic resistance patterns and inform effective treatment strategies.

The implementation of the acute care surgery model in the management of patients with acute appendicitis - A 5-year single-center, retrospective experience: An observational study.

We conducted this study to assess the effects of the acute care surgery (ACS) model in the management of patients with acute appendicitis (AA) based on our 5-year single-center, retrospective experience. The current single-center, retrospective, observational study was conducted in a consecutive series of the patients with AA who had been surgically treated at a tertiary referral hospital in Seoul, Korea, between January 2016 and December 2020. At our institution, the ACS model was first introduced in March 2018. Therefore, our clinical series of the patients were divided into 2 groups: the pre-ACS group (March 2014 to February 2018) and the post-ACS group (March 2018 to December 2022). Key time intervals include emergency department registration to request for surgical consultation, request for surgical consultation to decision on surgery, decision-to-operating room, time to decision on surgery and length of emergency department stay. Moreover, outcomes include rates of perforation and complications and discharge within 24 or 48 hours. We compared key time intervals, outcomes, and length of hospital stay between the 2 groups. A total of 900 patients with AA were finally included in the current study, 447 and 453 of whom were divided into the pre-ACS group (n = 447) and the post-ACS group (n = 453), respectively. There were significant differences in key time intervals, outcomes, and length of hospital stay between the 2 groups (P < .05). In conclusion, our results showed that the implementation of the ACS model was effective in improving key time intervals, rates of perforation, and discharge within 24 or 48 hours in the patients with AA.

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.

Ultrasound imaging of bowel obstruction in infants and children.

We review the etiologies of bowel obstruction in infants and children that can be identified on ultrasound (US) including perforated appendicitis, intussusception, foreign body ingestion, colonic volvulus, intra-abdominal mass lesions, internal hernia, and stricturing inflammatory bowel disease. US can potentially identify the cause of bowel obstruction in these age groups, without the need for additional cross-sectional imaging, and can aid in patient management including interventional and surgical planning. Hence, it is important to be familiar with the sonographic imaging findings of bowel obstruction in infants and children.

The diagnostic value of serum hepcidin in acute appendicitis.

BACKGROUND: Acute appendicitis (AA) is the primary cause of acute abdomen in patients presenting to the emergency department with abdominal pain. Limited studies have explored the relationship between serum hepcidin levels and AA. This study aimed to measure serum hepcidin levels in patients undergoing surgery with a preliminary diagnosis of AA and to assess whether these levels can serve as a biochemical marker for diagnosing AA. METHODS: This study included patients aged 18 or older who presented to the emergency department between April 2018 and May 2019 and underwent surgery with a diagnosis of AA. The cohort comprised 94 patients with surgical pathology results compatible with AA (Group A), 16 patients with results not compatible with AA (Group B), and 42 healthy controls. Serum hepcidin levels were measured from venous blood samples. RESULTS: Mean hepcidin levels were 1750±285 pg/mL in Group A, 1349±381 pg/mL in Group B, and 1066±225 pg/mL in the control group. Statistically significant differences in serum hepcidin levels were observed between Group A and the control group (p<0.05). CONCLUSION: Hepcidin levels were significantly higher in patients with AA compared to both the control group and patients with surgically confirmed non-AA pathology. Therefore, hepcidin may serve as a useful adjunct in diagnosing acute appendicitis.