Usefulness of extended inflammatory parameters related to neutrophil activation reported by Sysmex XN-1000 hematology analyzer for predicting complicated acute appendicitis. Comparison with canonical inflammatory laboratory tests.

AIM: Accurate diagnosis of complicated appendicitis is of importance to ensure that patients receive early and effective treatment, minimizing the risk of postoperative complications to promote successful recovery. Biochemical markers are a promising tool to identify complicated appendicitis. We aimed to evaluate the potential role of novel parameters related with neutrophil activation, known as "Extended Inflammation Parameters" (EIP), included in blood cell count reported by Sysmex XN-Series analyzers, compared to other canonical biomarkers in identifying complicated appendicitis. METHOD: Prospective observational study including patients with confirmed diagnosis of acute appendicitis. C-reactive protein (CRP), procalcitonin, cell blood count, including white blood cell (WBC), absolute neutrophil (ANC) and immature granulocyte (IG) count and EIP (neutrophil reactivity [NEUT-RI] and granularity intensity [NEUT-GI]) were analyzed before surgery. Their accuracy to diagnose complicated appendicitis was tested in an ROC curve analysis. RESULTS: Our population study included 119 patients, and appendicitis was complicated in 58 (48.7%). NLR, CRP and procalcitonin levels, ANC and IG count and NEUT-RI and NEUT-GI were higher in patients with complicated appendicitis. Regarding accuracy for complicated appendicitis, CRP was the biomarker with the highest performance (ROC AUC: 0.829), with an optimal cutoff of 73.1 mg/L (sensitivity: 63.8%, specificity: 88.5%). NEUT-RI and NEUT-GI achieved both significant but poor accuracy, with ROC AUC of 0.606 and 0.637, respectively. CONCLUSIONS: Novel laboratory tests reported by Sysmex XN-Series analyzers have poor accuracy for identifying complicated appendicitis. In this study, CRP was the biomarker with the highest performance and may be useful as predictor of the severity of acute appendicitis.

Intravenous antibiotic therapy after laparoscopic appendectomy in acute complicated appendicitis: the patient clinical response is the key.

INTRODUCTION: The guidelines about acute complicated appendicitis (ACA) recommend 3-5 days of postoperative intravenous antibiotics (IVA). Nevertheless, the time selected by the surgeon can vary according to patient clinical response, ACA type, and professional experience. Once an adequate clinical response is obtained, the change from IVA to oral antibiotic (OA) could be realized without the waiting time established with satisfactory results. OBJECTIVE: Determine if a short course of IVA and/or switch to oral route is safe based on the patient clinical response. MATERIALS AND METHODS: Observational prospective cohort study from a general surgery reference center database since July 2019. RESULTS AND CONCLUSION: 48 patients with ACA intraoperative findings were included. Regarding postoperative antibiotic management, only preoperative IVA: 7 (14.58%), IVA 1-3 days: 1 (20.83%), IVA 1-3 days and change to OA: 21 (43.75%), IVA > 3 days: 6 (12.5%), and only OA: 3 (27.08%). The bivariate analysis did not show statistically significant differences in reconsultation (p = 0.81), rehospitalization (p = 0.44), and surgical site infection (p = 0.56) between the antibiotic scheme based on the postoperative clinical response and the traditional one regarding intra-abdominal collection rate, the hospital stays, and hospitalization costs.

INTRODUCTION: Las guías sobre apendicitis aguda complicada (ACA) recomiendan 3-5 días de antibióticos intravenosos (IVA) postoperatorios. No obstante, el tiempo seleccionado por el cirujano puede variar según la respuesta clínica del paciente, tipo de ACA y experiencia profesional. Una vez obtenida una adecuada respuesta clínica, el cambio de IVA a antibiótico oral (OA) podría realizarse sin esperar el tiempo establecido con resultados satisfactorios. OBJETIVO: Determinar si un ciclo corto de IVA y/o el cambio a OA según la respuesta clínica del paciente es seguro. MATERIALES Y MÉTODOS: Estudio observacional de cohorte prospectivo a partir de la base de datos de un centro de referencia en cirugía general desde julio del 2019. RESULTADOS Y CONCLUSIÓN: Se incluyeron 48 pacientes con hallazgos intraoperatorios de ACA. En cuanto al manejo antibiótico postoperatorio, solo IVA preoperatorio: 7 (14.58%), IVA 1-3 días: 1 (20.83%), IVA 1-3 días y cambio OA: 21 (43.75%), IVA > 3 días: 6 (12.5%) y solo OA: 3 (27.08%). El análisis bivariado no mostró diferencias estadísticamente significativas en la reconsulta (p = 0.81), la rehospitalización (p = 0.44) y la infección del sitio operatorio (p = 0.56) entre el esquema de antibióticos basado en la respuesta clínica postoperatoria y el tradicional con respecto a tasa de colección intrabdominal, estancia hospitalaria y costos de hospitalización.

Cuerpo extraño como causa de apendicitis aguda complicada / Foreign body as a cause of complicated acute appendicitis

La apendicitis aguda es una de las patologías más comunes en el ámbito hospitalario. Las formas complicadas pueden ser causadas por objetos puntigudos, afilados, delgados o alargados, ingeridos de forma accidental, y representan una causa inusual con una prevalencia del 0,0005 %

Acute appendicitis is one of the most common pathologies in the hospital setting. The complicated forms can be caused by pointed, sharp, thin or elongated objects, accidentally ingested, and represent an unusual cause with a prevalence of 0.0005%.

Factores asociados a la apendicitis aguda complicada en un hospital público de la ciudad de Ica, octubre 2018 ­ setiembre 2019 / Factors associated with complicated acute appendicitis in a public hospital in the City of Ica, october 2018 ­ september 2019

La apendicitis aguda es el cuadro quirúrgico de urgencia más frecuente, y es la causa principal de abdomen agudo quirúrgico. Objetivo: Identificar los factores asociados a la apendicitis aguda complicada en un hospital público de la ciudad de Ica. Material y Métodos: Estudio descriptivo, observacional, analítico, prospectivo, no experimental. Muestra: Constituida por 147 pacientes mayores de 14 años postoperados de apendicitis aguda, obtenidos de diciembre 2018 a julio 2019, utilizándose como base, formularios y/o fichas validados a nivel internacional y adaptado a nuestra realidad, para recojo de información de la historia clínica del paciente, y una encuesta con 3 reactivos de respuestas dicotómicas. Resultados: Predominó el sexo masculino 56,5% y el grupo etario de 20 a 29 años 32,7%. Según la clasificación clínica: Mostró apendicitis aguda complicada 53,1% (78 pacientes) y apendicitis aguda no complicada 46,9% (69 pacientes). Referente a estadios histopatológicos fue flemonosa o supurada 33,3%, gangrenosa o necrótica y perforada con 26,5% ambos, y congestiva o catarral 13,6%. El tiempo transcurrido entre el inicio de los síntomas y el ingreso al hospital fue de menos de 24 horas 51,7%. Tiempo transcurrido entre el ingreso al hospital y la intervención quirúrgica reportó más de 6 horas con 68%. La automedicación fue 65,3%, no recibieron atención médica pre hospitalaria 59,9%. En las complicaciones intraabdominales predomina la peritonitis localizada y plastrón apendicular con 50% y 12,5% respectivamente. Conclusiones: La apendicitis aguda complicada se asoció a factores como la automedicación y el tiempo transcurrido entre el inicio de los síntomas y la intervención quirúrgica. (AU)

The appendicitis acute is the most frequent emergency surgical condition, and is the leading cause of acute surgical abdomen. Objective: To identify the factors associated with complicated acute appendicitis in a public hospital in the city of Ica. Material and Methods:Descriptive, observational, analytical, prospective, non-experimental study. Sample:Made up of 147 patients over 14 years of age after acute appendicitis, obtained from December 2019 to July 2019, using as a base, forms and / or files validated internationally and adapted to our reality, in which information was collected from the patient history, and a survey with 3 reagents of dichotomous responses. Results: The male sex was 56.5% and the age group of 20 to 29 years old was 32.7%. According to the clinical classification: He showed complicated acute appendicitis 53.1% (78 patients) and uncomplicated acute appendicitis 46.9% (69 patients). Regarding histopathological stages, 33.3% were phlegmonous or suppurated, gangrenous or necrotic and perforated with 26.5% both, and 13.6% congestive or catarrhal. The time between the onset of symptoms and admission to the hospital was less than 24 hours 51.7%. Time between hospital admission and surgery reported more than 6 hours with 68%. Self-medication was 65.3%, 59.9% did not receive prehospital medical care. In intra-abdominal complications, localized peritonitis and appendicular plastrón predominate with 50% and 12.5% respectively. Conclusions: Complicated acute appendicitis was associated with factors such as self-medication and the time elapsed between the onset of symptoms and surgical intervention. (AU)

Apendicitis aguda recurrente en pacientes apendicectomizados / Relapsed appendicitis in appendectomized patients

RESUMEN Introducción: La apendicitis aguda es la causa más común de abdomen agudo, que precisa de tratamiento quirúrgico mediante apendicectomía abierta o laparoscópica. La apendicitis del muñón o recurrente, en la que ocurre la inflamación del remanente apendicular, es una complicación tardía infrecuente de la apendicectomía. Objetivo: Identificar las posibles causas de la apendicitis recurrente, así como las medidas relacionadas con su prevención. Métodos: Se realizó una revisión de la literatura actualizada sobre el tema en formato digital, en publicaciones en idioma inglés y español. Conclusiones: La prevención de la apendicitis del muñón se basa en resecar el apéndice a menos de 0,5 cm de su base; los pacientes, con frecuencia, presentan síntomas análogos a los de antes de la primera cirugía, sin embargo, existe un incremento del riesgo de peritonitis y de graves complicaciones debido al retraso diagnóstico y terapéutico; es una causa poco frecuente de dolor abdominal en pacientes apendicectomizados, por lo que se debe guardar una alta sospecha para su diagnóstico precoz y tratamiento oportuno(AU)

ABSTRACT Introduction: Acute appendicitis is the most common cause of acute abdomen, which requires surgical treatment by open or laparoscopic appendectomy. Recurrent appendicitis of the stump, in which inflammation of the appendicular remnant occurs, is an infrequent late complication of appendectomy. Objective: To identify the possible causes of recurrent appendicitis, as well as the measures related to its prevention. Methods: A review of the updated literature on the subject was carried out in digital format, in publications in English and Spanish. Conclusions: Prevention of appendicitis of the stump is based on resecting the appendix less than 0.5 cm from its base; Patients frequently present symptoms similar to those before the first surgery, however, there is an increased risk of peritonitis and serious complications due to delayed diagnosis and therapy; It is a rare cause of abdominal pain in appendectomized patients, so high suspicion should be kept for its early diagnosis and prompt treatment(AU)