Annals of Coloproctology

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Reviews

Inflammatory/benign bowel disease

Clinical outcomes and optimal indications for nonoperative management of acute appendicitis in adult patients: a comprehensive literature review: Hyun Gu Lee, In Ja Park; Ann Coloproctol. 2025;41(2):107-118. Published online April 16, 2025; DOI: https://doi.org/10.3393/ac.2023.00192.0027

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Appendectomy as the standard treatment for acute appendicitis has been challenged by accumulating evidence supporting nonoperative management with antibiotics as a potential primary treatment. This review aimed to summarize the clinical outcomes and the optimal indications for nonoperative management of acute appendicitis in adults. Current evidence suggests that uncomplicated and complicated appendicitis have different pathophysiologies and should be treated differently. Nonoperative management for uncomplicated appendicitis was not inferior to appendectomy in terms of complications and length of stay, with less than a 30% failure rate at 1 year. The risk of perforation and postoperative complications did not increase even if nonoperative management failed. Complicated appendicitis with localized abscess or phlegmon could also be treated conservatively, with a success rate of more than 80%. An interval appendectomy following successful nonoperative management is recommended only for patients over the age of 40 years to exclude appendiceal malignancy. The presence of appendicoliths increased the risk of treatment failure and complications; thus, it may be an indication for appendectomy. Nonoperative management is a safe and feasible option for both uncomplicated and complicated appendicitis. Patients should be informed that nonoperative management may be a safe alternative to surgery, with the possibility of treatment failure.

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Appendicolith in non-operative management of acute appendicitis: Implications for recurrence and future directions
Ju Tian
World Journal of Clinical Cases.2025;[Epub] CrossRef

Benign bowel disease

Colorectal screening following appendectomy in adult patients: a systematic review: Francesco Esposito, Marco Del Prete, Matilde Magri, Fanny Dufour, Alexandre Cortes; Ann Coloproctol. 2024;40(5):417-423. Published online August 1, 2024; DOI: https://doi.org/10.3393/ac.2023.00528.0075

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Abstract PDF

Purpose
Although the association between appendicitis and colorectal cancer in older patients has received attention, postoperative colorectal screening through endoscopy is not currently recommended. This study conducted a systematic review of the literature on colorectal screening following appendectomy in adult patients.
Methods
A literature search was performed using online databases. Studies reporting colorectal surveillance after appendectomy in adult patients were retrieved for assessment.
Results
Eight articles including a total of 3,995 patients were published between 2013 and 2023. An age of 40 years was the lower threshold in 6 of the 8 articles. Postoperative colorectal screening occurred in 771 patients (19.3%). Endoscopy was performed in 95.2% of cases and computed tomography–colonography in 4.8%. During endoscopic examinations, a lesion was discovered in 184 of 771 patients (24.0%), and an adenomatous polyp was found in 154 of 686 patients (22.5%). The overall cancer rate was 3.9% (30 of 771 patients). The tumor was located in the right-sided colon in 46.7% of the patients, in the cecum in 20.0%, in the rectum in 16.7%, in the left-sided colon in 10.0%, and in the sigmoid colon in 6.7%.
Conclusion
Performing post-appendectomy colorectal screening in patients >40 years of age could allow early detection of an underlying lesion.

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An Unusual Culprit Behind Right Lower Quadrant Pain: Cecal Adenocarcinoma Initially Suspected as Appendicitis in an Elderly Female Patient
Michail Angelos Papaoikonomou, Europi Michailidou, Aggeliki Chlorou, Nikolaos Krokos
Cureus.2025;[Epub] CrossRef
Impact of CT‐Detected Appendiceal Fecoliths on Clinical and Histopathological Outcomes in Acute Appendicitis: A Retrospective Cohort Study
Taeyoung Son, Ekua Brenu, Sergei Tsakanov, Lynne Mann
ANZ Journal of Surgery.2025; 95(12): 2550. CrossRef

Original Articles

Benign bowel disease

Implications of bacteriological study in complicated and uncomplicated acute appendicitis: Sorin Cimpean, Alberto Gonzalez Barranquero, Ion Surdeanu, Benjamin Cadiere, Guy-Bernard Cadiere; Received February 28, 2022 Accepted July 7, 2022 Published online November 10, 2022; DOI: https://doi.org/10.3393/ac.2022.00157.0022 [Epub ahead of print]

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Abstract PDF

Purpose
Bacteriological sample in the presence of intra-abdominal free fluid is necessary to adapt the antibiotherapy and to prevent the development of resistance. The aim was to evaluate the differences between uncomplicated acute appendicitis (UAA) and complicated acute appendicitis (CAA) in terms of bacterial culture results and antibiotic resistance, and to evaluate the factors linked with CAA.
Methods
We performed a single-center, retrospective observational study of all consecutive patients who presented with appendicular peritonitis and underwent emergent surgery in a tertiary referral hospital in Brussels, Belgium, between January 2013 and December 2020. The medical history, parameters at admission, bacterial culture, antibiotic resistance, and postoperative outcomes of 268 patients were analyzed. UAA was considered catarrhal or phlegmonous inflammation of the appendix. CAA was considered gangrenous or perforated appendicitis.
Results
Positive microbiological cultures were significantly higher in the CAA group (68.2% vs. 53.4%). The most frequently isolated bacteria in UAA and CAA cultures were Escherichia coli (37.9% and 48.6%, respectively). Most observed resistances were against ampicillin (28.9% and 21.7%) and amoxicillin/clavulanic acid (16.4% and 10.5%) in UAA and CAA, respectively. A higher Charlson Comorbidity Index, an elevated white blood cell count, an open procedure, and the need for drainage were linked to CAA. Culture results, group of bacterial isolation, and most common isolated bacteria were not related to CAA.
Conclusion
CAA presented a higher rate of positive cultures with increased identification of gram-negative bacteria. Bacterial culture from the peritoneal liquid does not reveal relevant differences in terms of antibiotic resistance.

Citations

Citations to this article as recorded by

Optimizing Antibiotic Management for Adult Patients Presenting with Acute Perforated Appendicitis: A Quality Improvement Study
Carlos Gallego-Navarro, Jason Beckermann, Maria E. Linnaus, Hayden J. Swartz, Shelby Stewart, Justin M. York, Ryan R. Gassner, Christopher A. Kasal, Annaliese G. Seidel, Corey J. Wachter, Kirstin J. Kooda, Jennifer R. Rich, Mark D. Sawyer
Surgical Infections.2025; 26(3): 143. CrossRef
The functional landscape of the appendix microbiome under conditions of health and disease
Md Shahjalal Sagor, Tarequl Islam, Noshin Tabassum Tamanna, Md. Kamrul Islam Bappy, Danishuddin, Md Azizul Haque, Maximilian Lackner
Gut Pathogens.2025;[Epub] CrossRef
Causative microbes and antibiotic susceptibility of acute appendicitis in adults and children
Chia-Hsiang Yu, Chia-Ning Chang, Chih-Chien Wang
Pediatrics & Neonatology.2024; 65(2): 159. CrossRef
The role of intraoperative swab during appendectomy in patients with uncomplicated and complicated appendicitis
Bruno Leonardo Bancke Laverde, Matthias Maak, Melanie Langheinrich, Stephan Kersting, Axel Denz, Christian Krautz, Georg F. Weber, Robert Grützmann, Maximilian Brunner
International Journal of Colorectal Disease.2023;[Epub] CrossRef

Benign GI diease,Benign diesease & IBD,Surgical technique

Clinical outcomes of locking polymeric clip for laparoscopic appendectomy in patients with appendicitis: a retrospective comparison with loop ligature: Seokwon Kim, Byong Ho Jeon, Sang Sik Cho, Ui Sup Shin, Sun Mi Moon; Ann Coloproctol. 2022;38(2):160-165. Published online January 18, 2022; DOI: https://doi.org/10.3393/ac.2021.00598.0085

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Abstract PDF

Purpose
This study aimed to compare the clinical outcomes of laparoscopic appendectomy (LA) according to the method of appendiceal stump closure.
Methods
Patients who underwent LA for appendicitis between 2010 and 2020 were retrospectively reviewed. Patients were classified into locking polymeric clip (LPC) and loop ligature (LL) groups. Clinical outcomes were compared between the groups.
Results
LPC and LL were used in 188 (56.6%) and 144 patients (43.4%), respectively for appendiceal stump closure. No significant differences were observed in sex, age, comorbidities, and the severity of appendicitis between the groups. The median operative time was shorter in the LPC group than in the LL group (64.5 minutes vs. 71.5 minutes, P=0.027). The median hospital stay was longer in the LL group than in the LPC group (4 days vs. 3 days, P=0.020). Postoperative incidences of intraabdominal abscess and ileus were higher in the LL group than in the LPC group (4.2% vs. 1.1%, P=0.082 and 2.8% vs. 0%, P=0.035; respectively). The readmission rate was higher in the LL group than that in the LPC group (6.3% vs. 1.1%, P=0.012).
Conclusion
Using LPC for appendiceal stump closure during LA for appendicitis was associated with lower postoperative complication rate, shorter operative time, and shorter hospital stay compared to the use of LL. Operative time above 60 minutes and the use of LL were identified as independent risk factors for postoperative complications in LA. Therefore, LPC could be considered a more favorable closure method than LL during LA for appendicitis.

Citations

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Fistula formation between urinary bladder and abdominal wall caused by bladder injury from surgical clips following laparoscopic appendectomy
Wei Zhou, Yong Suo, Tian-Yan Luo, Long-Gang Wang
Asian Journal of Surgery.2025; 48(6): 3926. CrossRef
Comparison of Polymer Clips Versus Endoloop Ligatures for Appendiceal Stump Closure in Laparoscopic Appendectomy
Madan Haravu Srikantegowda, Shilpashree Channasandra Shekar, Vinod Nayak S
Cureus.2025;[Epub] CrossRef
Comparison of polymeric clip and endoloop in laparoscopic appendectomy: A systematic review and meta-analysis
Aashish Kumar, Muhammad Saqlain Mustafa, Muhammad Ashir Shafique, Abdul Haseeb, Hussain Sohail Rangwala, Haimath Kumar, Burhanuddin Sohail Rangwala, Adarsh Raja, Sandesh Raja, Syed Muhammad Sinaan Ali
Surgery.2024; 176(5): 1329. CrossRef
Advantages of using a polymeric clip versus an endoloop during laparoscopic appendectomy in uncomplicated appendicitis: a randomized controlled study
Kil-yong Lee, Jaeim Lee, Youn Young Park, Seong Taek Oh
World Journal of Emergency Surgery.2023;[Epub] CrossRef

Case Report

Benign bowel disease

Perioperative considerations for acute appendicitis in patients with COVID-19 infection: two case reports: In-Kyeong Kim, Seung-jin Kwag, Han-Gil Kim, Young-Tae Ju, Seung-Jun Lee, Tae-Jin Park, Sang-Ho Jeong, Eun-Jung Jung, Jin-Kwon Lee; Ann Coloproctol. 2023;39(6):521-525. Published online December 7, 2021; DOI: https://doi.org/10.3393/ac.2021.00647.0092

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1 Citations

Abstract PDF

We report considerations related with surgery through 2 cases of acute apendicitis with COVID-19 infection. In November and December 2020, two patients infected with COVID-19 developed acute apendicitis and underwent emergency surgery. In case 1, an 84-year-old woman was asymptomatic and diagnosed with acute apendicitis on the 20th day of infection. She was discharged after surgery without complication. In contrast, case 2 was a 69-year-old male patient with pneumonia treated with antibiotics, steroids and remdesivir. After surgery, he was hospitalized for a long duration due to persistent pneumonia and wound complications. We should perform appendectomy in well-established negative pressure operating rooms, personal protective equipment, and protocols. Since the physical examination and blood tests were limited, image examination like computed tomography scan should be considered if acute apendicitis is suspected. If the patient has pneumonia before surgery, it can get worse after surgery, and complications such as wound infections can occur.

Citations

Citations to this article as recorded by

COVID-19-specific risk factor for early post-appendectomy complications (EPAC) in older patients: a retrospective study
Tamer A. A. M. Habeeb, A. Hussain, Jose Bueno-Lledó, M. E. Giménez, A. Aiolfi, M. Chiaretti, I. A. Kryvoruchko, M. N. Manangi, Abd Al-Kareem Elias, Abdelmonem A.M Adam, Mohamed A. Gadallah, Saad Mohamed Ali Ahmed, Ahmed Khyrallh, Mohammed H. Alsayed, Esma
Techniques in Coloproctology.2025;[Epub] CrossRef

Original Article

Risk factors for prolonged hospitalization and delayed treatment completion after laparoscopic appendectomy in patients with uncomplicated acute appendicitis: Jiyoung Shin, Myong Hoon Ihn, Kyung Sik Kim, Sang Hyun Kim, Jihyoun Lee, Sangchul Yun, Sung Woo Cho; Ann Coloproctol. 2023;39(1):50-58. Published online November 18, 2021; DOI: https://doi.org/10.3393/ac.2021.00773.0110

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Abstract PDF Supplementary Material

Purpose
We sought to identify the risk factors for prolonged hospitalization and delayed treatment completion after laparoscopic appendectomy in patients with uncomplicated acute appendicitis.
Methods
The study retrospectively analyzed 497 patients who underwent laparoscopic appendectomies for uncomplicated appendicitis between January 2018 and December 2020. The patients were divided into an early discharge group (≤2 days) and a late discharge group (>2 days) based on the length of hospital stay (LOS). The patients were also divided into uneventful and complicated groups according to the need for additional treatment after standard follow-up.
Results
Thirty-seven patients (7.4%) were included in the late discharge group. The mean LOS of the late discharge groups was 3.9 days. There were significant differences according to age, preoperative C-reactive protein (CRP), and operative time between the 2 groups. Only operative time was significantly associated with prolonged LOS in multivariate analysis. Thirty-five patients (7.0%) were included in the complicated group. The mean duration of treatment in the uneventful and complicated groups was 7.4 and 25.3 days, respectively. Significant differences existed between the uneventful and complicated groups in preoperative body temperature, preoperative CRP levels, maximal appendix diameter, and the presence of appendicoliths. In multivariate analysis, preoperative CRP levels and maximal appendix diameter were independent predictors of delayed treatment completion.
Conclusion
Shorter operative time is desirable to ensure minimal hospital stay in patients with uncomplicated appendicitis. Further efforts are needed to ensure that patients with uncomplicated appendicitis do not experience delayed treatment completion after laparoscopic appendectomies.

Citations

Citations to this article as recorded by

Association between preoperative neutrophil-to-lymphocyte ratio and length of stay in pediatric patients undergoing laparoscopic appendectomy: a retrospective cohort study
Ming Liu, Yunpeng Gou, Ping Yang
BMC Pediatrics.2025;[Epub] CrossRef
Comparative Outcomes of Immediate and Delayed Wound Closure Techniques in Appendectomies for Gangrenous Appendicitis
Anzar Usman, Esha Akbar, Aliha Mukhtar, Iqra Nasir, Usama Rehman, Adil Iqbal, Muhammad Umar Umar
DEVELOPMENTAL MEDICO-LIFE-SCIENCES.2024; 1(3): 18. CrossRef
Non-linear association between C-reactive protein levels and length of stay in pediatric appendicitis patients undergoing laparoscopic appendectomy
Ming Liu, Ping Yang, Yunpeng Gou
Frontiers in Pediatrics.2024;[Epub] CrossRef
Nomogram prediction model for length of hospital stay following laparoscopic appendectomy in pediatric patients: a retrospective study
Ming Liu, Ping Yang, Yunpeng Gou, Qiang Chen, Dong Xu
Frontiers in Pediatrics.2024;[Epub] CrossRef

Case Reports

A rare presentation of low-grade appendiceal mucinous neoplasm within an amyand’s hernia: a case report: Hani Atiqah Saim, Ian Chik, Fahrol Fahmy Jaafar, Zamri Zuhdi, Razman Jarmin, Azlanudin Azman; Ann Coloproctol. 2023;39(2):183-187. Published online October 18, 2021; DOI: https://doi.org/10.3393/ac.2021.00430.0061

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Abstract PDF

An Amyand’s hernia is characterised as the presence of the appendix in an inguinal hernial sac. During laparoscopic cholecystectomy for gallbladder polyps, an incidental Amyand’s hernia was discovered in a 75-year-old female patient. On examination, the hernia contained an appendiceal mucocele but no evidence of perforation. An open appendicectomy with tension-free mesh repair was performed for the hernia. The histopathological report of the appendix was a low-grade appendiceal mucinous neoplasm (LAMN), an entity that is just as rare as an Amyand’s hernia. The patient had the right inguinal swelling for over 10 years but it was thought to be an inguinal intramuscular cyst as reported on a previous abdominal ultrasound. Mucocele of the appendix may have a benign or malignant appendiceal progress, leading to individualised diagnosis and treatment. We review an Amyand’s hernia with LAMN and discuss the asymptomatic tendency yet malignant potential of appendiceal mucoceles along with treatment strategies.

Citations

Citations to this article as recorded by

Molecular characterization of Pseudomyxoma peritonei with single-cell and bulk RNA sequencing
Ye Jin Ha, Seong-Hwan Park, Seon-Kyu Kim, Ka Hee Tak, Jeong-Hwan Kim, Chan Wook Kim, Yong Sik Yoon, Seon-Young Kim, Jong Lyul Lee
Scientific Data.2025;[Epub] CrossRef
Incidental appendiceal mucocele discovery: A case series and literature review
Nathaniel Grabill, Mena Louis, Jonathan W. Ray, Ana Tucker, Travelyan Walker, James Chambers
International Journal of Surgery Case Reports.2025; 131: 111281. CrossRef
Complicated Appendicitis Associated With Appendiceal Mucinous Neoplasm Within Amyand’s Hernia in a Patient With Previous Hernia Repair: A Case Report and Literature Review
Carlos A Navarro-Castañeda, Luis A Pérez-Silva, Rubén A Sandoval-Barba, Nubia A Ramírez-Buensuceso-Conde, Jorge Farell-Rivas
Cureus.2024;[Epub] CrossRef

Benign bowel disease

A fecalith mimicking a bladder calculus secondary to an appendicovesical fistula: a case report: Mauricio Gonzalez-Urquijo, Andrea Romero-Davila, MaryCarmen Mendoza-Silva, Antonio Nassim Halun Treviño, Mario Rodarte-Shade, Gerardo Gil-Galindo; Ann Coloproctol. 2023;39(4):362-365. Published online July 21, 2021; DOI: https://doi.org/10.3393/ac.2020.00311.0044

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Abstract PDF: An appendicovesical fistula is defined as an abnormal communication between the appendix and the urinary bladder, with only a few cases reported in the literature. It is very challenging to make an early diagnosis, due to the inability of conventional imaging modalities to detect this unique pathology. The symptoms are often mild, and there are not any specific signs or symptoms that might suggest this type of anomalous communication. We report a case of a 27-year-old male patient who presented difficulty for initiating urination, dysuria, and persistent urinary tract infections. An abdominal x-ray showed a large calculus inside the bladder. A cystoscopy was performed, where the tip of the appendix was seen protruding inside the bladder with a large fecalith adhered to the bladder wall. An appendectomy and partial cystectomy with primary repair were auspiciously achieved. A review of the literature is also presented.

Benign GI diease,Rare disease & stoma

De Garengeot’s Hernia Treated With a Hybrid Approach: A Case Report: Mohamed Alkashty, Ben Dickinson, Giovanni D. Tebala; Ann Coloproctol. 2021;37(Suppl 1):S55-S57. Published online May 28, 2021; DOI: https://doi.org/10.3393/ac.2020.09.21.2

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Abstract PDF

De Garengeot’s hernia happens when an inflamed or ischemic appendix is located within an incarcerated femoral hernia. We hereby report a case of De Garengeot’s hernia treated with a combined open and laparoscopic approach. An 80-year-old male presented to the emergency department with a 1-day history of a tender right inguinal mass. A computed tomography scan revealed a direct right inguinal hernia containing an incarcerated appendix. At surgery, the diagnosis of a strangulated appendix within a femoral hernia was made. To avoid a wide disruption of the right groin region, the ischemic appendix was reduced into the abdomen and removed laparoscopically. The femoral defect was treated by open plug repair. De Garengeot’s hernia may represent a surgical challenge. A combined open and laparoscopic approach is a good option in these cases.

Citations

Citations to this article as recorded by

Two Cases of De Garengeot Hernia: Combined Laparoscopic and Open Surgical Approach
Michelle M Dugan, MD
Journal of Pediatric Advance Research.2025; : 1. CrossRef
The Utility of Minimally Invasive Surgery in the Emergency Management of Femoral Hernias: A Systematic Review
Paul Shuttleworth, Shariq Sabri, Andrei Mihailescu
Journal of Abdominal Wall Surgery.2023;[Epub] CrossRef
Transverse colon and omental incarceration in femoral hernia: a case report
Badhaasaa Beyene Bayissa, Ayantu Mekonnon Borena
Journal of Surgical Case Reports.2023;[Epub] CrossRef

Original Articles

Benign GI diease

Routine Intraoperative Bacterial Culture May Be Needed in Complicated Appendicitis: Jung Tack Son, Gue Chun Lee, Hyung Ook Kim, Taewoon Kim, Donghyoun Lee, Sung Ryol Lee, Kyung Uk Jung, Hungdai Kim, Ho-Kyung Chun; Ann Coloproctol. 2020;36(3):155-162. Published online June 30, 2020; DOI: https://doi.org/10.3393/ac.2019.11.04.1

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14 Citations

Abstract PDF

Purpose
Choosing the appropriate antibiotic is important for treatment of complicated appendicitis. However, increasing multidrug resistant bacteria have been a serious problem for successful treatment. This study was designed to identify bacteria isolated from patients with complicated appendicitis and reveal their susceptibilities for antibiotics and their relationship with patient clinical course.
Methods
This study included patients diagnosed with complicated appendicitis and examined the bacterial cultures and antimicrobial susceptibilities of the isolates. Data were retrospectively collected from medical records of Kangbuk Samsung Hospital from January 2008 to February 2018.
Results
The common bacterial species cultured in complicated appendicitis were as follows: Escherichia coli (n=113, 48.9%), Streptococcus spp. (n=29, 12.6%), Pseudomonas spp. (n=23, 10.0%), Bacteriodes spp. (n=22, 9.5%), Klebsiella (n=11, 4.8%), and Enterococcus spp. (n=8, 3.5%). In antibiotics susceptibility testing, the positive rate of extended-spectrum beta lactamase (ESBL) was 9.1% (21 of 231). The resistance rate to carbapenem was 1.7% (4 of 231), while that to vancomycin was 0.4% (1 of 231). E. coli was 16.8% ESBL positive (19 of 113) and had 22.1% and 19.5% resistance rates to cefotaxime and ceftazidime, respectively. Inappropriate empirical antibiotic treatment (IEAT) occurred in 55 cases (31.8%) and was significantly related with organ/space surgical site infection (SSI) (7 of 55, P=0.005).
Conclusion
The rate of antibiotic resistance organisms was high in community-acquired complicated appendicitis in Koreans. Additionally, IEAT in complicated appendicitis may lead to increased rates of SSI. Routine intraoperative culture in patients with complicated appendicitis may be an effective strategy for appropriate antibiotic regimen.

Citations

Citations to this article as recorded by

Optimizing Antibiotic Management for Adult Patients Presenting with Acute Perforated Appendicitis: A Quality Improvement Study
Carlos Gallego-Navarro, Jason Beckermann, Maria E. Linnaus, Hayden J. Swartz, Shelby Stewart, Justin M. York, Ryan R. Gassner, Christopher A. Kasal, Annaliese G. Seidel, Corey J. Wachter, Kirstin J. Kooda, Jennifer R. Rich, Mark D. Sawyer
Surgical Infections.2025; 26(3): 143. CrossRef
A Prospective Analysis of the Burden of Multi-Drug-Resistant Pathogens in Acute Appendicitis and Their Implication for Clinical Management
Faruk Koca, Sara Fatima Faqar-Uz-Zaman, Claudia Reinheimer, Michael Hogardt, Volkhard A. J. Kempf, Paul Ziegler, Andreas A. Schnitzbauer, Armin Wiegering, Wolf Otto Bechstein, Patrizia Malkomes
Antibiotics.2025; 14(4): 378. CrossRef
Bacteriological Profile and Antimicrobial Resistance in Intraoperative Purulent Samples From Acute Appendicitis: A 3‐Year Retrospective Analysis
Quanwei Wang, Xiao Xu, Weiwei Ma, Chengcheng Huang, Liqing Cao, Yaru Zhang
ANZ Journal of Surgery.2025;[Epub] CrossRef
Culture-based bacterial evaluation of the appendix lumen and antibiotic susceptibility of acute appendicitis in Japan: A single-center retrospective analysis
Hiroe Kitahara, Yonfan Park, Kai Seharada, Masaki Yoshimura, Akira Horiuchi, Yukihiko Karasawa
Medicine.2024; 103(29): e39037. CrossRef
Do Cultures From Percutaneously Drained Intra-abdominal Abscesses Change Treatment? A Retrospective Review
Andrew C. Esposito, Yuqi Zhang, Nupur Nagarkatti, William D. Laird, Nathan A. Coppersmith, Vikram Reddy, Ira Leeds, Anne Mongiu, Walter Longo, Ritche M. Hao, Haddon Pantel
Diseases of the Colon & Rectum.2023; 66(3): 451. CrossRef
Bacterial pathogens in pediatric appendicitis: a comprehensive retrospective study
Julia Felber, Benedikt Gross, Arend Rahrisch, Eric Waltersbacher, Evelyn Trips, Percy Schröttner, Guido Fitze, Jurek Schultz
Frontiers in Cellular and Infection Microbiology.2023;[Epub] CrossRef
An Update on Acute Appendicitis in Lebanon: Insights From a Single-Center Retrospective Study
Nagham Bazzi, Samer Dbouk, Ahmad Rached, Sadek Jaber, Hala Bazzi, Manal Jrad, Mariam Bazzi
Cureus.2023;[Epub] CrossRef
Bacterial peritonitis in paediatric appendicitis; microbial epidemiology and antimicrobial management
Keir Bhaskar, Simon Clarke, Luke S. P. Moore, Stephen Hughes
Annals of Clinical Microbiology and Antimicrobials.2023;[Epub] CrossRef
Aerobic Intraoperative Abdominal Cavity Culture Modifies Antibiotic Therapy and Reduces the Risk of Surgical Site Infection in Complicated Appendicitis with Peritonitis
Víctor Manuel Quintero-Riaza, Romario Chancí-Drago, Natalia Guzmán-Arango, Pablo Posada-Moreno, Tatiana López-Sandoval, Isabel Cristina Ramírez-Sánchez, Johanna Marcela Vanegas-Munera
Journal of Gastrointestinal Surgery.2023; 27(11): 2563. CrossRef
Does the Covid-19 pandemic have an effect on wound culture in patients undergoing appendectomy? A Case Control Study
Hacı BOLAT, Tuğba AVAN MUTLU
Journal of Contemporary Medicine.2022; 12(2): 332. CrossRef
Are We Hitting the Target?
Julia Elrod, Fatima Yarmal, Christoph Mohr, Martin Dennebaum, Michael Boettcher, Deirdre Vincent, Konrad Reinshagen, Ingo Koenigs
Pediatric Infectious Disease Journal.2022; 41(6): 460. CrossRef
Is Routine Intra-operative Gram Stain, Culture, and Sensitivity during an Appendectomy is Effective in Decreasing the Rate of Post-operative Infective Complications?
Muqdad Fuad, Ahmed Modher, Mohammed Habash
Open Access Macedonian Journal of Medical Sciences.2022; 10(B): 868. CrossRef
Die Bedeutung mikrobiologischer Ergebnisse für die Therapie der komplizierten Appendizitis – eine monozentrische Fall-Kontroll-Studie
F-X. Anzinger, K. Rothe, S. Reischl, C. Stöss, A. Novotny, D. Wilhelm, H. Friess, P-A. Neumann
Die Chirurgie.2022; 93(10): 986. CrossRef
Implications of bacteriological study in complicated and uncomplicated acute appendicitis
Sorin Cimpean, Alberto Gonzalez Barranquero, Ion Surdeanu, Benjamin Cadiere, Guy-Bernard Cadiere
Annals of Coloproctology.2022;[Epub] CrossRef

Benign GI diease

Irrigation Versus Suction Alone During Laparoscopic Appendectomy for Uncomplicated Acute Appendicitis: Tae Gyeong Lee, Soomin Nam, Hyung Soon Lee, Jin Ho Lee, Young Ki Hong, Jung Gu Kang; Ann Coloproctol. 2020;36(1):30-34. Published online February 29, 2020; DOI: https://doi.org/10.3393/ac.2019.06.25

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Abstract PDF

Purpose
To compare the surgical outcomes of peritoneal irrigation versus suction alone during laparoscopic appendectomy and to identify the risk factors of surgical site infection in patients with uncomplicated acute appendicitis.
Methods
Data from patients with uncomplicated acute appendicitis between January 2014 and March 2016 were reviewed. We compared the irrigation and suction alone groups with regard to the following parameters: postoperative complication incidence rate, length of hospital stay, operation time, time to flatus, time to diet commencement, and duration of postoperative antibiotic.
Results
A total of 578 patients underwent laparoscopic appendectomy for uncomplicated acute appendicitis. Twenty-five patients were excluded from the analysis because of need for drain insertion, loss to follow-up, simultaneous surgery for another indication, presence of an appendix tumor, or pregnancy. A total of 207 patients (37.4%) had undergone irrigation, and 346 patients (62.6%) received suction alone during laparoscopic appendectomy. The preoperative fever rate was significantly higher in the irrigation group than in the suction alone group. Operative time was also significantly longer in the irrigation group than in the suction alone group (53.8 ± 18.5 minutes vs. 57.8 ± 21.4 minutes, P = 0.027). The postoperative complication rate was higher in the irrigation group than in the suction alone group (4.5% vs. 12.6%, P = 0.001). Multiple logistic regression analysis showed that irrigation and preoperative fever were risk factors for surgical site infection after laparoscopic appendectomy for uncomplicated acute appendicitis.
Conclusion
There is no advantage to irrigating the peritoneal cavity over suction alone during laparoscopic appendectomy for uncomplicated acute appendicitis. Irrigation may actually prolong the operative time and therefore be detrimental.

Citations

Citations to this article as recorded by

Wound Irrigation Prior to Closure During Routine Upper-Extremity Surgery: Is There a Difference in Wound Complications?
Marco Foreman, Isabella Amador, Arman Tabarestani, Kevin A. Hao, Jonathan Benjamin, Jed Casauay, Oluwaferanmi Dada, Persis Desai, Aaron Jennings, Adrienne Orriols, Reed Popp, Supreeya A. Saengchote, Anton Khlopas, Keegan Hones, Richard Hutchison, Jongmin
HAND.2025;[Epub] CrossRef
Establishment and validation of a nomogram for predicting postoperative intestinal adhesion in children with acute appendicitis
Dezhao Liu, Yuchi Wang, Liyun Sun, Lijia Pan, Junkui Wang, Ying Lu, Zhao Cui, Jingying Li, Hui Geng
BMC Pediatrics.2024;[Epub] CrossRef
Management of appendicitis: appendicectomy, antibiotic therapy, or both?
Elroy P. Weledji, Anutebeh V. Zisuh, Eleanore Ngounou
Annals of Medicine & Surgery.2023; 85(4): 897. CrossRef
Wound Irrigation Using Wet Gauze May Reduce Surgical Site Infection Following Laparoscopic Appendectomy
Abdullah Al-Sawat, Ji Yeon Mun, Sung Hoon Yoon, Chul Seung Lee
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To Reduce the Incidence of Postoperative Intraabdominal Abscess, the Application of Nonoperative Management Should be Circumspect Considering Patient Factors and the Nature of Acute Appendicitis
You Jin Lee, Kwang Hyun Yoon
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Effect and safety of peritoneal lavage for appendectomy: A meta-analysis
Yi-Ting Yen, El-Wui Loh, Ka-Wai Tam
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A Novel Suction-and-Irrigation Laparoscopic Surgical Instrument: Internal Design and Preclinical Performance Evaluation
Sang Wook Yi
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Aspiration versus peritoneal lavage in appendicitis: a meta-analysis
Gloria Burini, Maria Chiara Cianci, Marco Coccetta, Alessandro Spizzirri, Salomone Di Saverio, Riccardo Coletta, Paolo Sapienza, Andrea Mingoli, Roberto Cirocchi, Antonino Morabito
World Journal of Emergency Surgery.2021;[Epub] CrossRef

Malignant disease

Increased Risk of Neoplasms in Adult Patients Undergoing Interval Appendectomy: Jungtak Son, Yong Jun Park, Sung Ryol Lee, Hyung Ook Kim, Kyung Uk Jung; Ann Coloproctol. 2020;36(5):311-315. Published online January 31, 2020; DOI: https://doi.org/10.3393/ac.2019.10.15.1

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Abstract PDF

Purpose
The low rate of recurrent appendicitis after initial nonsurgical management of complicated appendicitis supports the recently implemented strategy of omitting routine interval appendectomy. However, several reports have suggested an increased incidence rate of neoplasms in these patients. We aimed to identify the risk of neoplasms in the population undergoing interval appendectomy.
Methods
This study retrospectively analyzed consecutive cases of appendicitis that were treated surgically between January 2014 and December 2018 at a single tertiary referral center. Patients were divided into 2 groups depending on whether they underwent immediate or interval appendectomy. Demographics and perioperative clinical and pathologic parameters were analyzed.
Results
All 2,013 adults included in the study underwent surgical treatment because of an initial diagnosis of acute appendicitis. Of these, 5.5% (111 of 2,013) underwent interval appendectomy. Appendiceal neoplasm was identified on pathologic analysis in 36 cases (1.8%). The incidence of neoplasm in the interval group was 12.6% (14 of 111), which was significantly higher than that of the immediate group (1.2% [22 of 1,902], P < 0.001). Conclusion: The incidence rate of neoplasms was significantly higher in patients undergoing interval appendectomy. These findings should be considered when choosing treatment options after successful nonsurgical management of complicated appendicitis.

Citations

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Incidental appendiceal neoplasms in a multicenter registry of appendicitis management
Aksel D. Laudon, Brendin R. Beaulieu-Jones, Swetha Duraiswamy, Frank F. Yang, Elizabeth Chen, Dave R. Flum, Kasey Lerner, Heather L. Evans, Lauren Thompson, Faris K. Azar, Alex Charboneau, Vlad V. Simianu, Victoria Valdes, Chaitan Narsule, Sabrina E. Sanc
Surgery.2026; 190: 109879. CrossRef
True Incidence of Appendiceal Neoplasms in Patients Presenting with Complicated Appendicitis: A Call for a Revised Management Algorithm
Laleh Foroutani, Jaeyun Jane Wang, Shreyas Kiran, Han Yin, Joshua Myszewski, Suwayda Ali, Amir Ashraf Ganjouei, Kenzo Hirose, Carlos Corvera, Eric Nakakura, Adnan Alseidi, Mohamed Abdelgadir Adam
Annals of Surgical Oncology.2026;[Epub] CrossRef
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JAMA Surgery.2025; 160(5): 526. CrossRef
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Noureldien Darwish, Lynn Guo, Eundong Park, Hwajeong Lee
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Muhammad Albahadili, Saif Mundher Ismael, Monaf Faik Al-Samarraee
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Can Appendiceal Neoplasms Be Predicted in Patients with Presumed Acute Appendicitis?
Şevki Pedük
European Journal of Therapeutics.2024; 30(2): 145. CrossRef
Beyond acute appendicitis: a single-institution experience of unexpected pathology findings after 989 consecutive emergency appendectomy
Pietro Fransvea, Caterina Puccioni, Gaia Altieri, Luca D’Agostino, Gianluca Costa, Giuseppe Tropeano, Antonio La Greca, Giuseppe Brisinda, Gabriele Sganga
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Erika Hissong
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Gizem Issin, Fatih Demir, Irem Guvendir Bakkaloglu, Diren Vuslat Cagatay, Hasan Aktug Simsek, Ismail Yilmaz, Ebru Zemheri
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Risk of appendiceal neoplasm after interval appendectomy for complicated appendicitis: A systematic review and meta-analysis
Roberto Peltrini, Valeria Cantoni, Roberta Green, Ruggero Lionetti, Michele D'Ambra, Carolina Bartolini, Marcello De Luca, Umberto Bracale, Alberto Cuocolo, Francesco Corcione
The Surgeon.2021; 19(6): e549. CrossRef
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R Peltrini, M Podda, S Di Saverio, U Bracale, F Corcione
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Modern Management of the Appendix
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Is a One Night Delay of Surgery Safe in Patients With Acute Appendicitis?: Jae Min Lee, Beom Seok Kwak, Young Jin Park; Ann Coloproctol. 2018;34(1):11-15. Published online February 28, 2018; DOI: https://doi.org/10.3393/ac.2018.34.1.11

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Abstract PDF

Purpose

With varied reports on the impact of time to appendectomy on clinical outcomes, the purpose of this study was to determine the effect of preoperative in-hospital delay on the outcome for patients with acute appendicitis.

Methods

A retrospective review of 1,076 patients who had undergone an appendectomy between January 2010 and December 2013 was conducted.

Results

The outcomes of surgery and the pathologic findings were analyzed according to elapsed time. The overall elapsed time from onset of symptoms to surgery was positively associated with advanced pathology, increased number of complications, and prolonged hospital stay. In-hospital elapsed time was not associated with any advanced pathology (P = 0.52), increased number of postoperative complications (P = 0.14), or prolonged hospital stay (P = 0.24). However, the complication rate was increased when the in-hospital elapsed time exceeded 18 hours.

Conclusion

Advanced pathology and postoperative complication rate were associated with overall elapsed time from symptom onset to surgery rather than in-hospital elapse time. Therefore, a short-term delay of an appendectomy should be acceptable.

Citations

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Nigam’s scoring system: a reliable and accurate scoring system to diagnose acute appendicitis
Vinod Kumar Nigam, Siddharth Nigam
International Surgery Journal.2025; 12(3): 326. CrossRef
Influence of the Timing of Antibiotic Administration and Control of Infectious Foci on the Prognosis of Adult Patients with Critical Surgical Sepsis
Pedro M. Garrido Benedicto, Pitter F. Cueto Quintana, Juan Antonio Brito Piris, Elisabet Garcia Mañosa, Karla Malpica Basurto, Raquel Enriquez Sanchez, Immaculada Vallverdú Perapoch, Jordi Camps Andreu
The Journal of Emergency Medicine.2025; 75: 137. CrossRef
Early versus delayed laparoscopic appendectomy for acute uncomplicated appendicitis in adults: a systematic review and meta-analysis
Iftikhar Khan, Soban Ali Qasim, Haris Mumtaz Malik, Muhammad Hamza, Umna Bhatti, FNU Sawaira, Syeda Wania Haider, Saad Khan, Ehsanullah Alokozay, Muhammad Abdullah Ali, Fariha Hasan, Muhammad Riyyan
BMC Surgery.2025;[Epub] CrossRef
Is the performance of acute appendectomy at different times of day equal, in terms of postoperative complications, readmission, death, and length of hospital stay? A Swedish retrospective cohort study of 4950 patients
Petter Nyström, Martin Nordberg, Lennart Boström
European Journal of Trauma and Emergency Surgery.2024; 50(3): 791. CrossRef
Does the timing of appendectomy affect outcomes and postoperative complications?
María San Basilio, Carlos Delgado-Miguel, Carla Ramírez-Amorós, María Sarmiento, Lucas Moratilla-Lapeña, Arturo Almeyda, Ricardo Mejía, Leopoldo Martínez
Pediatric Surgery International.2023;[Epub] CrossRef
Timing of surgical operation for patients with intra-abdominal infection: A systematic review and meta-analysis
Shu-Rui Song, Yang-Yang Liu, Yu-Ting Guan, Ruo-Jing Li, Lei Song, Jing Dong, Pei-Ge Wang
World Journal of Gastrointestinal Surgery.2023; 15(10): 2320. CrossRef
Patient Outcomes Related to In-Hospital Delays in Appendicectomy for Appendicitis: A Retrospective Study
Oliver Claydon, Billy Down, Sidharth Kumar
Cureus.2022;[Epub] CrossRef
Possibility for avoidance of urgent nighttime operations for acute appendicitis in a regional core university hospital
Tomoya Tago, Mitsugi Shimoda, Ryosuke Imazato, Ryutaro Udou, Kenji Katsumata, Akihiko Tsuchida, Shuji Suzuki
Asian Journal of Endoscopic Surgery.2022; 15(1): 22. CrossRef
Daytime versus nighttime laparoscopic appendectomy in term of complications and clinical outcomes: A retrospective study of 1001 appendectomies
Amjad A. Shah, Raed M. Al-Zoubi, Ahmad R. Al-Qudimat, Mohamed Amine Rejeb, Laxmi Kumari Ojha, Sharif Abdulzem, Khadija Qadir, Sara Sameer, Ahmad Zarour, Mohamed Said Ghali
Heliyon.2022; 8(12): e11911. CrossRef
Nighttime Appendectomy is Safe and has Similar Outcomes as Daytime Appendectomy: A Study of 1198 Appendectomies
T. Mönttinen, H. Kangaspunta, J. Laukkarinen, M. Ukkonen
Scandinavian Journal of Surgery.2021; 110(2): 227. CrossRef
Revisiting delayed appendectomy in patients with acute appendicitis
Jian Li
World Journal of Clinical Cases.2021; 9(20): 5372. CrossRef
Laparoscopic Appendectomy in the Days of COVID-19
Roi Abramov, Mariya Neymark, Asaf Harbi, Hayim Gilshtein
Surgical Laparoscopy, Endoscopy & Percutaneous Techniques.2021; 31(5): 599. CrossRef
Did the COVID-19 Pandemic Prolong the Time Till Diagnosis and Worsen Outcomes for Children with Acute Appendicitis?
Idilė Vansevičienė, Danielė Bučinskaitė, Dalius Malcius, Aušra Lukošiūtė-Urbonienė, Mindaugas Beržanskis, Emilis Čekanauskas, Vidmantas Barauskas
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Megan Power Foley, Michael MacLean, Ciaran Doyle, Timothy Nugent, Michael E. Kelly, Fady Narouz, Brian Mehigan, Paul McCormick, John Larkin
Irish Journal of Medical Science (1971 -).2020; 189(2): 649. CrossRef
Invited commentary on “Short-term outcome after appendectomy is related to preoperative delay but not to the time of day of the procedure: A nationwide retrospective cohort study of 9224 patients”
Xuan Liang, Yanxia Sun
International Journal of Surgery.2020; 79: 140. CrossRef
Quality Outcomes in Appendicitis Care: Identifying Opportunities to Improve Care
Syed Mohammad Umar Kabir, Magda Bucholc, Carol-Ann Walker, Opeyemi O. Sogaolu, Saqib Zeeshan, Michael Sugrue
Life.2020; 10(12): 358. CrossRef
Effect of Delay to Operation on Outcomes in Patients with Acute Appendicitis: a Systematic Review and Meta-analysis
Jian Li, Run Xu, Deng-Min Hu, Yao Zhang, Tu-Ping Gong, Xue-Lian Wu
Journal of Gastrointestinal Surgery.2019; 23(1): 210. CrossRef
Is postponed laparoscopic appendectomy justified for patients with acute appendicitis?
Atsushi Kohga, Kiyoshige Yajima, Takuya Okumura, Kimihiro Yamashita, Jun Isogaki, Kenji Suzuki, Katsuaki Muramatsu, Akira Komiyama, Akihiro Kawabe
Asian Journal of Endoscopic Surgery.2019; 12(4): 423. CrossRef
Is early appendectomy in adults diagnosed with acute appendicitis mandatory? A prospective study
Salma Abu Foul, Ella Egozi, Ahmad Assalia, Yoram Kluger, Ahmad Mahajna
World Journal of Emergency Surgery.2019;[Epub] CrossRef
Preoperative Clinical Factors Associated with Short‐Stay Laparoscopic Appendectomy
Aurélie Vuagniaux, Olivier Gié, Fabio Butti, Pedro Manuel Marques‐Vidal, Nicolas Demartines, Styliani Mantziari
World Journal of Surgery.2019; 43(11): 2771. CrossRef

Which One is Better? Comparison of the Acute Inflammatory Response, Raja Isteri Pengiran Anak Saleha Appendicitis and Alvarado Scoring Systems: Mohammad Yasin Karami, Hadi Niakan, Navid Zadebagheri, Parviz Mardani, Zahra Shayan, Iman Deilami; Ann Coloproctol. 2017;33(6):227-231. Published online December 31, 2017; DOI: https://doi.org/10.3393/ac.2017.33.6.227

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Abstract PDF

Purpose

Acute appendicitis (AA) is one of the most common causes of an acute abdomen. The accuracies of the Alvarado and the acute inflammatory response (AIR) scores in the diagnosis of appendicitis is very low in Asian populations, so a new scoring system, the Raja Isteri Pengiran Anak Saleha Appendicitis (RIPASA) system, was designed recently. We applied and compared the Alvarado, AIR, and RIPASA scores in the diagnoses of appendicitis in the Iranian population.

Methods

We prospectively compared the RIPASA, Alvarado, and AIR systems by applying them to 100 patients. All the scores were calculated for patients who presented with right quadrant pain. Appendectomies were performed; then, the postoperative pathology reports were correlated with the scores. Scores of 8, 7, and 5 or more are optimal cutoffs for the RIPASA, Alvarado, and AIR scoring systems, respectively. The sensitivities, specificities, positive predictive values, negative predictive values (NPVs), positive and negative likelihood ratios (LRs) for the 3 systems were determined.

Results

The sensitivity and the specificity of the RIPASA score were 93.18% and 91.67%, respectively. The sensitivities of the Alvarado and the AIR scores were both 78.41%. The specificities of the Alvarado and the AIR scores were 100% and 91.67%, respectively. The RIPASA score correctly classified 93% of all patients confirmed with histological AA compared with 78.41% for the Alvarado and the AIR scores.

Conclusion

The RIPASA scoring system had more sensitivity, better NPV, a positive LR, and a less negative LR for the Iranian population whereas the Alvarado scoring system was more specific.

Citations

Citations to this article as recorded by

Clinical scores for acute appendicitis in adults: A systematic review and meta-analysis of diagnostic accuracy studies
Luis Adrian Alvarez-Lozada, Bernardo Alfonso Fernandez-Reyes, Francisco Javier Arrambide-Garza, Mariana García-Leal, Neri Alejandro Alvarez-Villalobos, Javier Humberto Martínez-Garza, Bernardo Fernández-Rodarte, Rodrigo E. Elizondo-Omaña, Alejandro Quirog
The American Journal of Surgery.2025; 240: 116123. CrossRef
31/w mit Mittelbauchschmerzen und einmaligem Erbrechen
Dorothea Sauer
Notfall + Rettungsmedizin.2025; 28(S2): 107. CrossRef
How successful are Alvarado and air scores in excluding gynecopathologies?
Goksever Akpinar, Batuhan Eyduran, Alaattin Karabulut, Baris Eker
Journal of Obstetrics and Gynaecology Research.2025;[Epub] CrossRef
Evaluating the Diagnostic Accuracy of the Alvarado Score and Abdominal Ultrasound for Acute Appendicitis: A Retrospective Single-Center Study
Saleh Al-wageeh, Qasem Alyhari, Faisal Ahmed, Abdulfattah Altam, Gubran Alshehari, Mohamed Badheeb
Open Access Emergency Medicine.2024; Volume 16: 159. CrossRef
EVALUATION OF ALVARADO SCORE IN DIAGNOSIS OF ACUTE APPENDICITIS
Sumia Dra
Libyan Journal of Medical Research.2024; 18(1): 172. CrossRef
Comparison of Alvarado score, appendicitis inflammatory response score (AIR) and Raja Isteri Pengiran Anak Saleha appendicitis (RIPASA) score in predicting acute appendicitis
Muhammad Zeb, Sabir Khan Khattak, Maryam Samad, Syed Shayan Shah, Syed Qasim Ali Shah, Abdul Haseeb
Heliyon.2023; 9(1): e13013. CrossRef
A systematic review and meta-regression for validation of the Alvarado score as a tool for predicting acute appendicitis
Sapna Gupta, Venkata S. Kolli, Kimberly Da Costa, Sariya Javed, Ahmed Ammar, Ashraf Rasheed
Annals of Medicine & Surgery.2023; 85(2): 111. CrossRef
Modificación de la efectividad diagnóstica de la escala RIPASA en pacientes con apendicitis aguda y consumo de analgésicos no esteroideos
Pedro Josué Araujo Ramírez, Ricardo Sanabria Trujillo, Sergio Hernández Aguilar, Francisco Javier Hernández Hernández
Acta Médica Grupo Ángeles.2023; 21(2): 123. CrossRef
Performance and diagnostic accuracy of scoring systems in adult patients with suspected appendicitis
David Eng Yeow Gan, Nik Ritza Kosai Nik Mahmood, Jitt Aun Chuah, Firdaus Hayati
Langenbeck's Archives of Surgery.2023;[Epub] CrossRef
Comparison of RIPASA and ALVARADO scores for risk assessment of acute appendicitis: A systematic review and meta-analysis
Giuliana Favara, Andrea Maugeri, Martina Barchitta, Andrea Ventura, Guido Basile, Antonella Agodi, Ibrahim Umar Garzali
PLOS ONE.2022; 17(9): e0275427. CrossRef
Diagnostic Accuracy Rates of Appendicitis Scoring Systems for the Stratified Age Groups
Emre Gonullu, Zulfu Bayhan, Recayi Capoglu, Barış Mantoglu, Burak Kamburoglu, Tarık Harmantepe, Fatih Altıntoprak, Unal Erkorkmaz, Roberto Cirocchi
Emergency Medicine International.2022; 2022: 1. CrossRef
Serum Bilirubin as a Predictor of Complications of Acute Appendicitis in Adults
K P C Muhammed Irfan, C Rajeev, A Mohamad Safwan, Shafy Ali Khan, K N Vijayan, Liju Varghese
Kerala Surgical Journal.2022; 28(2): 182. CrossRef
Consensus Statement of the Italian Polispecialistic Society of Young Surgeons (SPIGC): Diagnosis and Treatment of Acute Appendicitis
Eleonora Guaitoli, Gaetano Gallo, Eleonora Cardone, Luigi Conti, Simone Famularo, Giampaolo Formisano, Federica Galli, Giuseppe Giuliani, Antonio Martino, Alessandro Pasculli, Romeo Patini, Domenico Soriero, Vincenzo Pappalardo, Gianmaria Casoni Pattacini
Journal of Investigative Surgery.2021; 34(10): 1089. CrossRef
Validation of the Appendicitis Inflammatory Response (AIR) Score
Manne Andersson, Blanka Kolodziej, Roland E. Andersson
World Journal of Surgery.2021; 45(7): 2081. CrossRef
Acute inflammatory response and Alvarado scoring systems in the diagnosis of acute appendicitis: which one is more accurate?
Abdoulhossein Davoodabadi, Hassan Zandi, Alireza Moravveji, Mohammad J. Azadchehr
Chirurgia.2021;[Epub] CrossRef
Diagnostic accuracy of Alvarado, RIPASA and Tzanakis scoring system in acute appendicitis: A prospective observational study
Pushkar Sharma, Ankit Jain, Gomathi Shankar, Sreerekha Jinkala, Uday S Kumbhar, Sreenath G Shamanna
Tropical Doctor.2021; 51(4): 475. CrossRef
Acute appendicitis–advances and controversies
Thomas Zheng Jie Teng, Xuan Rong Thong, Kai Yuan Lau, Sunder Balasubramaniam, Vishal G Shelat
World Journal of Gastrointestinal Surgery.2021; 13(11): 1293. CrossRef
RIPASA versus Alvarado score in the assessment of suspected appendicitis in children: a prospective study
Tülin Öztaş, Muhammet Asena
Annals of Pediatric Surgery.2021;[Epub] CrossRef
Predictive value of scoring systems for the diagnosis of acute appendicitis in emergency department patients: Is there an accurate one?
Rohat Ak, Fatih Doğanay, Ebru Unal Akoğlu, Haldun Akoğlu, Aslı Bahar Uçar, Erdem Kurt, Cansu Arslan Turan, Ozge Onur
Hong Kong Journal of Emergency Medicine.2020; 27(5): 262. CrossRef
Comparison of Raja Isteri Pengiran Anak Saleha Appendicitis and modified Alvarado scoring systems in the diagnosis of acute appendicitis
Nurullah Damburacı, Barış Sevinç, Murat Güner, Ömer Karahan
ANZ Journal of Surgery.2020; 90(4): 521. CrossRef
Empfehlungen zur Therapie der akuten Appendizitis
M. Andric, J. C. Kalff, W. Schwenk, S. Farkas, W. Hartwig, A. Türler, R. Croner
Der Chirurg.2020; 91(9): 700. CrossRef
COMPARİSON OF ALVARADO AND RIPASA SCORES İN PATİENTS WİTH ACUTE APPENDİCİTİS
Mine ESMER GÖKÇE, İ̇lhan KORKMAZ, Yusuf TEKİN, Sefa YURTBAY, Erdal DEMİRTAŞ, Orhan ÖZSOY, Sedat ÖZBAY, Fatma KUKUL GÜVEN
Cumhuriyet Medical Journal.2020;[Epub] CrossRef
Predictive Value of Alvarado, Acute Inflammatory Response, Tzanakis and RIPASA Scores in the Diagnosis of Acute Appendicitis
Senol Tahir, Andrej Nikolovski, Martina Ambardjieva, Petar Markov, Dragoslav Mladenovik, Gjulsen Selim, Beti Zafirova-Ivanovska, Vlado Janevski
Lietuvos chirurgija.2020; 19(3-4): 109. CrossRef
Scoring Systems in Acute Appendicitis - A Review
Aditya Vijay Mundada, Yeshwant Lamture, Meenakshi Yeola
Journal of Evolution of Medical and Dental Sciences.2020; 9(51): 3881. CrossRef
Can RIPASA Scoring System Predict the Pathological Stage of Acute Appendicitis?
Banu Karapolat
Emergency Medicine International.2019; 2019: 1. CrossRef

Unexpected Appendiceal Pathologies and Their Changes With the Expanding Use of Preoperative Imaging Studies: Hong Yeol Yoo, Jaewoo Choi, Jongjin Kim, Young Jun Chai, Rumi Shin, Hye Seong Ahn, Chang-Sup Lim, Hae Won Lee, Ki-Tae Hwang, In Mok Jung, Jung Kee Chung, Seung Chul Heo; Ann Coloproctol. 2017;33(3):99-105. Published online June 30, 2017; DOI: https://doi.org/10.3393/ac.2017.33.3.99

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7 Citations

Abstract PDF

Purpose

The preoperative diagnosis of acute appendicitis is often challenging. Sometimes, pathologic results of the appendix embarrass or confuse surgeons. Therefore, more and more imaging studies are being performed to increase the accuracy of appendicitis diagnoses preoperatively. However, data on the effect of this increase in preoperative imaging studies on diagnostic accuracy are limited. We performed this study to explore unexpected appendiceal pathologies and to delineate the role of preoperative imaging studies in the diagnosis of acute appendicitis.

Methods

The medical records of 4,673 patients who underwent an appendectomy for assumed appendicitis between 1997 and 2012 were reviewed retrospectively. Pathological results and preoperative imaging studies were surveyed, and the frequencies of pathological results and preoperative imaging studies were investigated.

Results

The overall rate of pathology compatible with acute appendicitis was 84.4%. Unexpected pathological findings, such as normal histology, specific inflammations other than acute appendicitis, neoplastic lesions, and other pathologies, comprised 9.6%, 3.3%, 1.2%, and 1.5%, respectively. The rate of unexpected pathological results was significantly reduced because of the increase in preoperative imaging studies. The decrease in normal appendices contributed the most to the reduction while other unexpected pathologies did not change significantly despite the increased use of imaging studies. This decrease in normal appendices was significant in both male and female patients under the age of 60 years, but the differences in females were more prominent.

Conclusion

Unexpected appendiceal pathologies comprised 15.6% of the cases. Preoperative imaging studies reduced them by decreasing the negative appendectomy rate of patients with normal appendices.

Citations

Citations to this article as recorded by

Changing trends in appendiceal pathology: a 16-year retrospective extension study of surgically removed appendices in a tropical teaching hospital
Nicholas Awodele Awolola, Andrea Oludolapo Akinjo, AbdulRazzaq Oluwagbemiga Lawal, Kabir Bolarinwa Badmos, Fatimah Biade Abdulkareem
BMC Gastroenterology.2025;[Epub] CrossRef
The appendix: An unexpected band obstruction
Rowan Klein Nulend, Rakesh Quinn, Kar Yin Fok, Nimalan Pathmanathan
Journal of Case Reports and Images in Surgery.2024; 10(1): 1. CrossRef
The Vermiform Appendix and Its Pathologies
Marian Constantin, Livia Petrescu, Cristina Mătanie, Corneliu Ovidiu Vrancianu, Adelina-Gabriela Niculescu, Octavian Andronic, Alexandra Bolocan
Cancers.2023; 15(15): 3872. CrossRef
Rising incidence of appendiceal neoplasms over time: Does pathological handling of appendectomy specimens play a role?
Hisham F. Bahmad, Abed Alhalim Aljamal, Juan Carlos Alvarez Moreno, Ali Salami, Philip Bao, Sarah Alghamdi, Robert J. Poppiti
Annals of Diagnostic Pathology.2021; 52: 151724. CrossRef
The Impact of Pathological Criteria on Pediatric Negative Appendectomy Rate
Caroline Maloney, Morris C. Edelman, Alexandra C. Bolognese, Aaron M. Lipskar, Barrie S. Rich
Journal of Pediatric Surgery.2019; 54(9): 1794. CrossRef
Communication and management of incidental pathology in 1,214 consecutive appendicectomies; a cohort study
Ned Kinnear, Bridget Heijkoop, Eliza Bramwell, Alannah Frazzetto, Amy Noll, Prajay Patel, Derek Hennessey, Greg Otto, Christopher Dobbins, Tarik Sammour, James Moore
International Journal of Surgery.2019; 72: 185. CrossRef
Unexpected Appendiceal Pathologies and Preoperative Imaging Studies on Patients With Acute Appendicitis
Byung Chun Kim
Annals of Coloproctology.2017; 33(3): 82. CrossRef

Single-Port Laparoscopic Interval Appendectomy for Perforated Appendicitis With a Periappendiceal Abscess: Sung Uk Bae, Woon Kyung Jeong, Seong Kyu Baek; Ann Coloproctol. 2016;32(3):105-110. Published online June 30, 2016; DOI: https://doi.org/10.3393/ac.2016.32.3.105

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8 Citations

Abstract PDF

Purpose

Nonoperative management followed by an interval appendectomy is a commonly used approach for treating patients with perforated appendicitis with abscess formation. As minimally-invasive surgery has developed, single-port laparoscopic surgery (SPLS) is increasingly being used to treat many conditions. We report our initial experience with this procedure using a multichannel single-port.

Methods

The study included 25 adults who underwent a single-port laparoscopic interval appendectomy for perforated appendicitis with periappendiceal abscess by using a single-port with or without needlescopic grasper between June 2014 and January 2016.

Results

Of the 25 patients, 9 (36%) required percutaneous drainage for a median of 7 days (5–14 days) after insertion, and 3 (12%) required conversion to reduced-port laparoscopic surgery with a 5-mm port insertion because of severe adhesions to adjacent organs. Of 22 patients undergoing SPLS, 13 underwent pure SPLS (52.0%) whereas 9 patients underwent SPLS with a 2-mm needle instrument (36.0%). Median operation time was 70 minutes (30–155 minutes), and a drainage tube was placed in 9 patients (36.0%). Median total length of incision was 2.5 cm (2.0–3.0 cm), and median time to soft diet initiation and length of stay in the hospital were 2 days (0–5 days) and 3 days (1–7 days), respectively. Two patients (8.0%) developed postoperative complications: 1 wound site bleeding and 1 surgical site infection.

Conclusion

Conservative management followed by a single-port laparoscopic interval appendectomy using a multichannel single-port appears feasible and safe for treating patients with acute perforated appendicitis with periappendiceal abscess.

Citations

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Single incision laparoscopic appendectomy with surgical-glove port is cost-effective and reliable in complicated acute appendicitis: A casecontrol multicenter study in Colombia
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Case Report

Xanthogranulomatous Appendicitis Mimicking Residual Burkitt's Lymphoma After Chemotherapy: Soomin Nam, Jeonghyun Kang, Sung-Eun Choi, Yu Ri Kim, Seung Hyuk Baik, Seung-Kook Sohn; Ann Coloproctol. 2016;32(2):83-86. Published online April 30, 2016; DOI: https://doi.org/10.3393/ac.2016.32.2.83

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Abstract PDF

The case of a 23-year-old female treated with aggressive high-dose therapy for Burkitt's lymphoma is reported. A positron emission tomography and computed tomography scan after completion of chemotherapy revealed a residual hypermetabolic lesion in the right pelvic cavity. A pelvic magnetic resonance imaging scan showed circumferential wall thickening at the tip of the appendix. A laparoscopic exploration and appendectomy were performed, and a pathologic examination of the resected appendix revealed xanthogranulomatous appendicitis. This is a rare case of a xanthogranulomatous appendicitis mimicking remnant Burkitt's lymphoma after completion of chemotherapy.

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Original Articles

Predictive Factors to Distinguish Between Patients With Noncomplicated Appendicitis and Those With Complicated Appendicitis: Tae Hyung Kim, Byung Sun Cho, Jae Hag Jung, Moon Soo Lee, Je Ho Jang, Chang Nam Kim; Ann Coloproctol. 2015;31(5):192-197. Published online October 31, 2015; DOI: https://doi.org/10.3393/ac.2015.31.5.192

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Abstract PDF

Purpose

Recently, randomized controlled trials have reported that conservative therapy can be a treatment option in patients with noncomplicated appendicitis. However, preoperative diagnosis of noncomplicated appendicitis is difficult. In this study, we determined predictive factors to distinguish patients with noncomplicated appendicitis from those with complicated appendicitis.

Methods

A total of 351 patients who underwent surgical treatment for acute appendicitis from January 2011 to December 2012 were included in this study. We classified patients into noncomplicated or complicated appendicitis groups based on the findings of abdominal computed tomography and pathology. We performed a retrospective analysis to find factors that could be used to discriminate between noncomplicated and complicated appendicitis.

Results

The mean age of the patients in the complicated appendicitis group (54.5 years) was higher than that of the patients in the noncomplicated appendicitis group (40.2 years) (P < 0.001), but the male-to-female ratios were similar. In the univariate analysis, the appendicocecal junction's diameter, appendiceal maximal diameter, appendiceal wall enhancement, periappendiceal fat infiltration, ascites, abscesses, neutrophil proportion, C-reactive protein (CRP), aspartate aminotransferase, and total bilirubin were statistically significant factors. However, in the multivariate analysis, the appendiceal maximal diameter (P = 0.018; odds ratio [OR], 1.129), periappendiceal fat infiltration (P = 0.025; OR, 5.778), ascites (P = 0.038; OR, 2.902), and CRP (P < 0.001; OR, 1.368) were statistically significant.

Conclusion

Several factors can be used to distinguish between noncomplicated and complicated appendicitis. Using these factors, we could more accurately distinguish patients with noncomplicated appendicitis from those with complicated appendicitis.

Citations

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Utilizing non-invasive biomarkers for early and accurate differentiation of uncomplicated and complicated acute appendicitis: a retrospective cohort analysis
Mehmet Torun, İsmail Ege Subaşı, Deniz Kol Özbay, Mehmet Ali Özbay, Hakan Özdemir
Scientific Reports.2025;[Epub] CrossRef
High Diagnostic Accuracy but Persistent Risk of Complicated Appendicitis: A Retrospective Analysis from Hail Province, Saudi Arabia
Alfatih Mohamed Ahmed Aljanib, Faisal Fawaz Alshammari, Fahad Maiyah Alshammari, Ali Ahmed Alqahtani, Bandar Alsaif, Jerold C. Alcantara, Abdulaziz Bin Ali Alshammari, Talal Alharazi
International Journal of Applied & Basic Medical Research.2025; 15(2): 85. CrossRef
Low-keV virtual monoenergetic images with rapid kilovoltage-switching DECT for differentiating complicated from uncomplicated appendicitis in adults
Dhanawin Wongsaengchan, Jitti Chatpuwaphat, Shanigarn Thiravit, Sasima Tongsai, Napakadol Noppakunsomboon, Rathachai Kaewlai
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Ahmed G Alsayaf Alghamdi, Saleh M Alzhrani, Amer Fayraq, Saif A Alzahrani
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Jochem C. G. Scheijmans, Wouter J. Bom, Umme Habiba Ghori, Anna A. W. van Geloven, Gerjon Hannink, Charles C. van Rossem, Lieke van de Wouw, Peter M. Huisman, Annemiek van Hemert, Rutger J. Franken, Steven J. Oosterling, Camiel Rosman, Lianne Koens, Jaap
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Veli Avci, Kemal Ayengin, Zubeyir Huyut, Mehmet Tahir Huyut, Lokman Soysal, Salim Bilici
Indian Journal of Surgery.2023; 85(5): 1139. CrossRef
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The American Journal of Emergency Medicine.2023; 67: 100. CrossRef
Risk factors for prolonged hospitalization and delayed treatment completion after laparoscopic appendectomy in patients with uncomplicated acute appendicitis
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Serdar SAHİN
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Predicting complicated appendicitis is possible without the use of sectional imaging—presenting the NoCtApp score
Jens Strohäker, Martin Brüschke, You-Shan Feng, Christian Beltzer, Alfred Königsrainer, Ruth Ladurner
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The American Journal of Emergency Medicine.2019; 37(11): 2097. CrossRef
Systematic Review and Meta-Analysis of CT Features for Differentiating Complicated and Uncomplicated Appendicitis
Hae Young Kim, Ji Hoon Park, Yoon Jin Lee, Sung Soo Lee, Jong-June Jeon, Kyoung Ho Lee
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Murat Özgür Kılıç, Cem Emir Güldoğan, İlhan Balamir, Mesut Tez
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Increased anatomic severity predicts outcomes
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Hakan Ataş, Murat Ö. Kılıç, Serdar G. Terzioğlu, Bariş Saylam
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International normalized ratio and serum C-reactive protein are feasible markers to predict complicated appendicitis
Maru Kim, Sung-Jeep Kim, Hang Joo Cho
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Byeong Geon Jeon, Hyuk Jung Kim, Kuk Hyun Jung, Sang Wook Kim, Jin Soo Park, Ki Ho Kim, Il Dong Kim, Sang-Jeon Lee
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Change in the Diagnosis of Appendicitis by Using a Computed Tomography Scan and the Necessity for a New Scoring System to Determine the Severity of the Appendicitis
Byung Wook Min
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Hyperbilirubinemia Is a Significant Indicator for the Severity of Acute Appendicitis: Young Ran Hong, Chul-Woon Chung, Jong Woo Kim, Chang Il Kwon, Dae Ho Ahn, Sung Won Kwon, Seong Ki Kim; J Korean Soc Coloproctol. 2012;28(5):247-252. Published online October 31, 2012; DOI: https://doi.org/10.3393/jksc.2012.28.5.247

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Abstract PDF

Purpose

This study aims to reveal more effective clinical or laboratory markers for the diagnosis of acute appendicitis and to score the severity based on a sufficiently large number of patients with acute appendicitis.

Methods

We identified 1,195 patients with acute appendicitis after excluding those with other causes of hyperbilirubinemia among the 1,271 patients that underwent a laparoscopic or an open appendectomy between 2009 and 2010. A retrospective chart review of the medical records, including laboratory and histologic results, was conducted. We then analyzed the data using univariate and multivariate analyses.

Results

Among the 1,195 patients, a laparoscopic appendectomy was performed in 685 cases (57.32%), and an open appendectomy was performed in 510 cases (42.68%). The univariate analysis demonstrated significant differences for white blood cell count (P < 0.0001), segmented neutrophils (P = 0.0035), total bilirubin (P < 0.0001), and systemic inflammatory response syndrome (SIRS) score between groups (P < 0.0001). The multivariate analysis demonstrated that total bilirubin (odds ratio, 1.772; 95% confidence interval, 1.320 to 2.379; P = 0.0001) and SIRS score (odds ratio, 1.583; 95% confidence interval, 1.313 to 1.908; P < 0.0001) have statistically significant diagnostic value for perforated appendicitis.

Conclusion

Hyperbilirubinemia is a statistically significant diagnostic marker for acute appendicitis and the likelihood of perforation.

Citations

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Hyperbilirubinemia and acute appendicitis: a cohort study
Harris BARTIMEUS, Ibrahim LABEDA, Julianus A. UWURATUW, Joko HENDARTO, Prihantono PRIHANTONO, Muhammad I. KUSUMA, Muhammad FARUK
Chirurgia.2025;[Epub] CrossRef
Role of immature granulocyte and blood biomarkers in predicting perforated acute appendicitis using machine learning model
Zeynep Kucukakcali, Sami Akbulut
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Hyperbilirubinemia as a Marker for Complicated Acute Appendicitis: A Systematic Review
Alicja Czyszczon, Bartosz Maczkowski, Aneta Tkaczyk, Marek Drozdz, Wiktoria Boral, Szymon Mikler, Magdalena Mandyna, Aleksandra Przelaskowska, Jan Pulinski
Cureus.2025;[Epub] CrossRef
Diagnostic Value of Hematological and Biochemical Markers in Pediatric Appendicitis: A ROC-Based Retrospective Evaluation
Sevgi Buyukbese Sarsu
Medical Bulletin of Haseki.2025; 63(5): 236. CrossRef
Diagnostic value of laboratory parameters for complicated appendicitis: A two‑center study
Qian Zhang, Hongwei Zhao, Fangli Wang, Wenqiang Li, Peng Zhang
Biomedical Reports.2024;[Epub] CrossRef
Letter to the Editor regarding “A novel Appendicitis TriMOdal prediction Score (ATMOS) for acute appendicitis in pregnancy: a retrospective observational study”
Rıfat Peksöz, Ferdi Cambaztepe, Sabri Selçuk Atamanalp
Updates in Surgery.2023; 75(1): 265. CrossRef
Individual biomarkers in the blood are not yet applicable in diagnosing complicated appendicitis: A scoping review
Binyamin Sikander, Jacob Rosenberg, Siv Fonnes
The American Journal of Emergency Medicine.2023; 67: 100. CrossRef
Elevated total and direct bilirubin are associated with acute complicated appendicitis: a single-center based study in Saudi Arabia
Mohammed S. Alfehaid, Ayman M. Babiker, Abdullah Hamad Alkharraz, Hamad yousef Alsaeed, Ali Abdullah Alzunaydi, Adi Abdulaziz Aldubaiyan, Hanan Abdalla Sinyan, Bshayr K. Alkhalaf, Rakan Alshuwaykan, Rehana Khalil, Osama Al-Wutayd
BMC Surgery.2023;[Epub] CrossRef
Significance of laboratory parameters in diagnosing acute appendicitis during pregnancy
Rıfat Peksöz, Esra Dişçi, Abdulkadir Kaya, Enes Ağırman, Ercan Korkut, Nurhak Aksungur, Necip Altundaş, Salih Kara, Sabri Selçuk Atamanalp
ANZ Journal of Surgery.2022; 92(1-2): 121. CrossRef
Hyperbilirubinemia and Hyponatremia as Predictors of Complicated Appendicitis
Abdullah Shuaib, Nour Alhamdan, Husain Arian, Mohamed Alaa Sallam, Ali Shuaib
Medical Sciences.2022; 10(3): 36. CrossRef
Evaluation of role of hyperbilirubinemia as a new diagnostic marker of complicated appendicitis
Sabyasachi Bakshi, Nilay Mandal
BMC Gastroenterology.2021;[Epub] CrossRef
Clinical predictors of gangrenous appendicitis: elevated total bilirubin level and computed tomography scan findings
Itsuki Naya, Kensuke Adachi, Koichi Takeuchi, Yuno Ariyama, Akihiro Hosaka, Kazuhiro Imamura, Yasuhiro Morita, Shigeki Matsubara, Alan Kawarai Lefor, Hisanaga Horie
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INTERNATIONAL JOURNAL OF SCIENTIFIC RESEARCH.2021; : 16. CrossRef
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Evaluation of Serum Bilirubin as a Predictive Marker for Simple and Complicated Appendicitis in Sulaimani Emergency Teaching Hospital
Seerwan Hama Shareef, Dara Ahmed Mohammed, Goran Ameer Ahmed
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Lack of utility of measuring serum bilirubin concentration in distinguishing perforation status of pediatric appendicitis
William Bonadio, Santina Bruno, David Attaway, Logesh Dharmar, Derek Tam, Peter Homel
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Hyperbilirubinaemia: its utility in non‐perforated appendicitis
Anna Sandstrom, David A. Grieve
ANZ Journal of Surgery.2017; 87(7-8): 587. CrossRef
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Amish Acharya, Sheraz R. Markar, Melody Ni, George B. Hanna
Surgical Endoscopy.2017; 31(3): 1022. CrossRef
Hyperbilirubinaemia alone cannot distinguish a perforation in acute appendicitis
Fábio R. Silva, Maria Inês da Rosa, Bruno R. Silva, Carla Simon, Maria Cecília Alexandre, Lidia R. Medeiros, Fabrício S. Bitencourt, Maria Eduarda Fernandes dos Reis
ANZ Journal of Surgery.2016; 86(4): 255. CrossRef
Predictive value of abnormally raised serum bilirubin in acute appendicitis: A cohort study
A.C. Chambers, S.L. Bismohun, H. Davies, P. White, A.V. Patil
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Diagnostic markers in acute appendicitis
Yahya A. Al-Abed, Nasser Alobaid, Fiona Myint
The American Journal of Surgery.2015; 209(6): 1043. CrossRef
Diagnostic accuracy of hyperbilirubinaemia in anticipating appendicitis and its severity
Sven Muller, Claudius Falch, Steffen Axt, Peter Wilhelm, Dirk Hein, Alfred Königsrainer, Andreas Kirschniak
Emergency Medicine Journal.2015; 32(9): 698. CrossRef
Serum total bilirubin elevation is a predictor of the clinicopathological severity of acute appendicitis
Satoshi Nomura, Masanori Watanabe, Osamu Komine, Takeshi Shioya, Tetsutaka Toyoda, Hideki Bou, Tetsuo Shibuya, Hideyuki Suzuki, Eiji Uchida
Surgery Today.2014; 44(6): 1104. CrossRef
Elevated serum bilirubin in assessing the likelihood of perforation in acute appendicitis: A diagnostic meta-analysis
Salvatore Giordano, Markus Pääkkönen, Paulina Salminen, Juha M. Grönroos
International Journal of Surgery.2013; 11(9): 795. CrossRef

Appendicitis during Pregnancy: The Clinical Experience of a Secondary Hospital: Soo Jung Jung, Do Kyung Lee, Jun Hyun Kim, Pil Sung Kong, Kyung Ha Kim, Sung Woo Bae; J Korean Soc Coloproctol. 2012;28(3):152-159. Published online June 30, 2012; DOI: https://doi.org/10.3393/jksc.2012.28.3.152

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45 Download
22 Citations

Abstract PDF

Purpose

Appendicitis is the most common condition leading to an intra-abdominal operation for a non-obstetric problem in pregnancy. The aim of this study was to examine our experience and to analyze the clinical characteristics and the pregnancy outcomes for appendicitis during pregnancy that was reported in Korea.

Methods

We reported 25 cases of appendicitis during pregnancy that were treated at Good Moonhwa Hospital from January 2004 to March 2010. We also analyzed appendicitis during pregnancy reported in Korea between 1970 and 2008 by a review of journals.

Results

The incidence of acute appendicitis during pregnancy was one per 568 deliveries. The mean age was 27.92 years old, the gestational stage at the onset of symptoms was the first trimester in 10 patients (40%), the second trimester in 14 patients (56%), and the third trimester in 1 patient (4%). Among the 25 cases, 21 were treated with an open appendectomy and 4 with laparoscopic appendectomies. The postoperative complications were 2 wound infections and 1 spontaneous abortion.

Conclusion

Our experience demonstrated that appendectomies on pregnant patients can be successfully performed at secondary hospitals.

Citations

Citations to this article as recorded by

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PARAMETERS ASSOCIATED WITH ACUTE APPENDICITIS IN PREGNANCY
Samet ŞAHİN, Eyüp Murat YILMAZ, Mahir KIRNAP, Ethem BİLGİÇ, Ahmet Ender DEMİRKIRAN
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Clinical Characteristics and Surgical Safety in Patients with Acute Appendicitis Aged over 80: Kwon Sang Moon, Yong Hwan Jung, Eun Hun Lee, Yong Hee Hwang; J Korean Soc Coloproctol. 2012;28(2):94-99. Published online April 30, 2012; DOI: https://doi.org/10.3393/jksc.2012.28.2.94

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Abstract PDF

Purpose

The aim of this study was to evaluate the clinical characteristics and treatment outcomes, including surgical safety, in patients over 80 years of age who underwent an appendectomy.

Methods

This study involved 160 elderly patients who underwent an appendectomy for acute appendicitis: 28 patients over 80 years old and 132 patients between 65 and 79 years old.

Results

The rate of positive rebound tenderness was significantly higher in the over 80 group (P = 0.002). Comparisons of comorbidity, diagnostic tool and delay in surgical treatment between the two groups were not statistically different. American Society of Anesthesiologists score was significantly higher in the over 80 group than in the 65 to 79 group (2.4 ± 0.5 vs. 1.6 ± 0.5; P < 0.00005). Comparisons of operative times and use of drainage between the two groups were not statistically different. In the pathologic findings, periappendiceal abscess was more frequent in the over 80 group (P = 0.011). No significant differences existed between the two groups when comparing the results of gas out and the time to liquid diet, but the postoperative hospital stay was significantly longer in the over 80 group (P = 0.001). Among the postoperative complications, pulmonary complication was significantly higher in the over 80 group (P = 0.005). However, operative mortality was zero in each group.

Conclusion

In case of suspicious appendicitis in elderly patients, efforts should be made to use aggressive diagnostic intervention, do appropriate surgery and prevent pulmonary complications especially in patients over 80 years of age.

Citations

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立民刘
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Techniques in Coloproctology.2025;[Epub] CrossRef
Appendicitis
Paulina Salminen, Jussi Haijanen, Peter C. Minneci, Giana Hystad Davidson, Marja A. Boermeester, Ed Livingston, Roland E. Andersson, Kyoung Ho Lee, David Flum
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Scheduled Surgery and Antibiotic Therapy in Catarrhal Acute Appendicitis
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A Clinical Comparison of Laparoscopic versus Open Appendectomy for Complicated Appendicitis: Sun Gu Lim, Eun Jung Ahn, Seong Yup Kim, Il Yong Chung, Jong-Min Park, Sei Hyeog Park, Kyoung Woo Choi; J Korean Soc Coloproctol. 2011;27(6):293-297. Published online December 31, 2011; DOI: https://doi.org/10.3393/jksc.2011.27.6.293

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25 Citations

Abstract PDF

Purpose

Although laparoscopic appendectomies (LAs) are performed universally, a controversy still exists whether the LA is an appropriate surgical approach to complicated appendicitis (CA). We retrospectively evaluated the outcomes of laparoscopic versus open appendectomies for CA.

Methods

We retrospectively analyzed 60 consecutive patients who were diagnosed as having CA from July 2009 to January 2011. Outcomes such as operative time, time to soft diet, length of hospital stay, and postoperative complications were analyzed.

Results

There were no statistically significant differences in operative time between the LA and the open appendectomy (OA) groups. Return to soft diet was faster in the LA group (2.1 ± 1.2 vs. 3.5 ± 1.5 days; P = 0.001). Length of hospital stay was shorter for the LA group (4.4 ± 2.3 vs. 5.8 ± 2.9 days; P = 0.045). The overall complication rates showed no statistically significant difference between the two groups. In cases involving a periappendiceal abscess, the LA had a significantly higher incidence of intra-abdominal abscess (IAA) and postoperative ileus (PI; P = 0.028).

Conclusion

The LA showed good results in terms of the time to soft diet, the length of hospital stay, and surgical site infection (SSI) whereas the overall complication rates were similar for the two groups. However, the LA was associated with significantly higher incidence of IAA and PI for the cases with a periappendiceal abscess. Therefore, when using a LA, the surgeon must take great care to minimize the incidence of IAA and PI if a periappendiceal abscess is present.

Citations

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B P Mao, G Collins, F E Ayeni, D J Vagg
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Ahmed A. Sabry, Mahmoud Menesy, Mohamed Kassem, Mostafa R. Elkeleny
The Egyptian Journal of Surgery.2023; 42(3): 736. CrossRef
Intra and Postoperative Advantages of Laparoscopy in the Treatment of Complicated Appendicitis
Andrej Nikolovski, Cemal Ulusoy
PRILOZI.2022; 43(2): 59. CrossRef
AAn Evaluation of the Choice of the Treatment for the Acute Appendicitis An Original Research
Srikanth N. Jarupla, Ganesh Vadthya, Mushtaq A. Chowdhary, Heena D. Tiwari, Pritee R. Pandey, Afroz K. Syed, Akriti Mahajan
Journal of Pharmacy and Bioallied Sciences.2022; 14(Suppl 1): S188. CrossRef
Predictors for prolonged length of stay after laparoscopic appendectomy for complicated acute appendicitis in adults
Aleix Martínez-Pérez, Carmen Payá-Llorente, Sandra Santarrufina-Martínez, Juan Carlos Sebastián-Tomás, Elías Martínez-López, Nicola de’Angelis
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A clinical comparison of laparoscopic versus open appendectomy for the treatment of complicated appendicitis: historical cohort study
Tomoya Takami, Tomoyuki Yamaguchi, Hiroyuki Yoshitake, Kotaro Hatano, Naoki Kataoka, Masafumi Tomita, Shinichiro Makimoto
European Journal of Trauma and Emergency Surgery.2020; 46(4): 847. CrossRef
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Ahmed Talha, Hany El-Haddad, Abd-Elhamid Ghazal, Gihan Shehata
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Andrej Nikolovski, Shenol Tahir, Dragoslav Mladenovikj
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Laparoscopic Versus Open Appendectomy for Appendicitis in Elderly Patients: Hyun Nam Baek, Yong Hwan Jung, Yong Hee Hwang; J Korean Soc Coloproctol. 2011;27(5):241-245. Published online October 31, 2011; DOI: https://doi.org/10.3393/jksc.2011.27.5.241

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Abstract PDF

Purpose

The appendectomy is the most common emergent surgical procedure in elderly patients. The increasing number of elderly persons has been accompanied by an increase in the number of cases of acute appendicitis in the elderly. In order to understand the clinical significance of a laparoscopic appendectomy for elderly patients with appendicitis, we investigated the results of a laparoscopic appendectomy for treating patients over 60 years of age with appendicitis and compared them with the results for an open technique.

Methods

We studied retrospectively patients over 60 years of age who underwent an appendectomy with either a laparoscopic (LA) or open (OA) technique for appendicitis between July 2007 and December 2009. There were 30 patients in the LA group and 47 patients in the OA group. The demographic data, operative time, length of the hospital stay, bowel movement, pain control, cost, complications and pre-existing disease were assessed.

Results

There were no significant differences between the LA and the OA groups with respect to pre-existing diseases, gender, age, American Society of Anesthesiologists (ASA) score and the number of cases of complicated appendicitis, operative time, length of hospital stay, and times of analgesics use. However, the proportion of early gas out (within POD #2) was significantly greater in the LA group (80% vs. 57%, P < 0.05), and postoperative complications were significantly lower in the LA group (7% vs. 32%, P < 0.01). The costs for the two groups were not significantly different.

Conclusion

A laparoscopic appendectomy is a safe and effective procedure in elderly patients and is not associated with any increase in morbidity. It can be recommended for routine use in treating elderly patients with appendicitis.

Citations

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Diagnostic Value of C-reactive Protein in Complicated Appendicitis: Hyoung-Min Moon, Beom-Seok Park, Duk-Jin Moon; J Korean Soc Coloproctol. 2011;27(3):122-126. Published online June 30, 2011; DOI: https://doi.org/10.3393/jksc.2011.27.3.122

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Abstract PDF

Purpose

Early detection of appendicitis has increased due to development of computed tomography and ultrasonography, yet we are frequently meeting complicated appendicitis, including perforation, abscess and a gangrenous appendicitis due to delayed diagnosis. For that reason, we want to evaluate predictive factors for the complicated appendicitis.

Methods

A total of 128 patients with appendicitis, after 13 patients with a duration of under 12 hours and 15 patients with pathological non-appendicitis were excluded from 156 patients, who visited Kwangju Christian Hospital from November 2008 to November 2010 were retrospectively reviewed.

Results

There were 62 patients (48.3%) with simple appendicitis and 66 patients (51.7%) with complicated appendicitis. In univariate analysis, age (P < 0.001), C-reactive protein (P < 0.001) and the diameter of the appendix (P = 0.006), were found to be significant. Multivariate analysis demonstrated that C-reactive protein was an independent predictor for complicated appendicitis (odds ratio, 1.371; 95% confidence interval, 1.155 to 1.628; P < 0.001). The cut-off value of C-reactive protein was set at 7.05 mg/dL by using receiver operating characteristic curve (0.805; sensitivity, 57.6%; specificity, 98.3%).

Conclusion

This study suggests that if C-reactive protein is above 7.05 mg/dL, immediate and proper management should be performed due to a high probability of complicated appendicitis, especially in young children or elderly patients who frequently present with vague symptoms.

Citations

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RIPASA and air scoring systems are superior to alvarado scoring in acute appendicitis: Diagnostic accuracy study
Meer M. Chisthi, Anilkumar Surendran, Jiju Therumpurathu Narayanan
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Risk factors for serious morbidity, prolonged length of stay and hospital readmission after laparoscopic appendectomy - results from Pol-LA (Polish Laparoscopic Appendectomy) multicenter large cohort study
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Scientific Reports.2019;[Epub] CrossRef
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Cy Lai, Yk Leung, Ca Graham
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Management of Appendicitis Presenting with Abscess or Mass: Jeong-Ki Kim, Seungbum Ryoo, Heung-Kwon Oh, Ji Sun Kim, Rumi Shin, Eun Kyung Choe, Seung-Yong Jeong, Kyu Joo Park; J Korean Soc Coloproctol. 2010;26(6):413-419. Published online December 31, 2010; DOI: https://doi.org/10.3393/jksc.2010.26.6.413

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Abstract PDF

Purpose

Management strategy in acute appendicitis patients initially presenting with abscess or mass is surrounded with controversy. This study was performed to identify the outcomes of management for this condition.

Methods

We retrospectively analyzed prospectively registered 76 patients (male:female = 39:37; mean age, 50.8 years) with appendicitis presenting with abscess or mass over a 9-year period at the Seoul National University Hospital. Patients were divided into three groups (emergency operation group, delayed operation group, and follow-up group), and clinical characteristics and outcomes of treatment were investigated.

Results

Twenty-eight patients (36.8%) underwent an emergency operation. Of the remaining 48 patients, 20 (41.7%) were initially treated with conservative management through the use of antibiotics only; the other 28 (58.3%) with and additional ultrasound-guided percutaneous drainage of the abscess. Twenty-six (54.2%) patients underwent planned operations after conservative management, and 22 (45.8%) were followed without surgery (median duration, 37.8 month), of which 3 (13%) underwent an appendectomy due to recurrent appendicitis (mean of 56.7 days after initial attack). There were no statistical differences in types of operation performed (appendectomy or ileocecectomy), postoperative complications, and postoperative hospital stay among the patients who underwent emergency operations, delayed operations and operations for recurrence during follow-up.

Conclusion

Although the recurrence rate was relatively low after conservative management for appendicitis patients presenting with abscess or mass, there was no difference in surgical outcome between the emergent, elective, or recurrent groups. Our results indicate that proper management of appendicitis with abscess or mass can be selected according to surgeon's preference.

Citations

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High Diagnostic Accuracy but Persistent Risk of Complicated Appendicitis: A Retrospective Analysis from Hail Province, Saudi Arabia
Alfatih Mohamed Ahmed Aljanib, Faisal Fawaz Alshammari, Fahad Maiyah Alshammari, Ali Ahmed Alqahtani, Bandar Alsaif, Jerold C. Alcantara, Abdulaziz Bin Ali Alshammari, Talal Alharazi
International Journal of Applied & Basic Medical Research.2025; 15(2): 85. CrossRef
A Case of Appendiceal Pinworms in an Adolescent Patient
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From Bedside to Bot-Side: Artificial Intelligence in Emergency Appendicitis Management
Koray Ersahin, Sebastian Sanduleanu, Sithin Thulasi Seetha, Johannes Bremm, Cavid Abbasli, Chantal Zimmer, Tim Damer, Jonathan Kottlors, Lukas Goertz, Christiane Bruns, David Maintz, Nuran Abdullayev
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Jae Gil Lee, Chang Sung Park, Im Kyung Kim
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Hussam Widatella, Ahmed Abdulmanan, Ibraheem Abdelraheem, Fadi Atwan, Sri Paran
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Masaaki Miyo, Shoichiro Urabe, Satoshi Hyuga, Tomo Nakagawa, Toshiya Michiura, Nobuyasu Hayashi, Kazuo Yamabe
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Zaza Demetrashvili, George Kenchadze, Irakli Pipia, Kakhi Khutsishvili, David Loladze, Eka Ekaladze, Giorgi Merabishvili, George Kamkamidze
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Ishfaq Ahmad Gilkar, Umer Mushtaq, Javid Ahmad Peer, Bilal Ahmed Mir, Yaqoob Hassan, Waseem Ahmad Dar
Journal of Evidence Based Medicine and Healthcare.2019; 6(3): 135. CrossRef
CLINICAL STUDY AND MANAGEMENT OF APPENDICULAR LUMP
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Minimally Invasive Treatment for Appendiceal Mass Formed After Acute Perforated Appendicitis
Enver Zerem, Suad Kunosić, Almin Handanagić, Dženan Jahić, Dina Zerem, Omar Zerem
Surgical Laparoscopy, Endoscopy & Percutaneous Techniques.2017; 27(3): 132. CrossRef
Therapeutic Consideration of Periappendiceal Abscess: an Evaluation of Non-surgical Treatment Followed by Minimally Invasive Interval Appendectomy
Yeong-Soo Jo, Song-Soo Yang, Yeong-Chul Im, Dong-Jin Park, Gyu-Yeol Kim
The Journal of Minimally Invasive Surgery.2017; 20(4): 129. CrossRef
The management of intra-abdominal infections from a global perspective: 2017 WSES guidelines for management of intra-abdominal infections
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Challenges in uncomplicated acute appendicitis
Fernando Resende, Ana Beatriz Almeida, José Costa Maia, Renato Bessa Melo
Journal of Acute Disease.2016; 5(2): 109. CrossRef
Management of Appendiceal Mass and Abscess. An 11-Year Experience
Zaza Demetrashvili, Giorgi Kenchadze, Irakli Pipia, Eka Ekaladze, George Kamkamidze
International Surgery.2015; 100(6): 1021. CrossRef
The role of current methods of X-ray diagnosis in caseof intraabdominal suppurative conplications caused bu colonic diseases
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2013 WSES guidelines for management of intra-abdominal infections
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World Journal of Emergency Surgery.2013;[Epub] CrossRef

Application of Single Incision Laparoscopic Surgery for Appendectomies in Patients with Complicated Appendicitis: Kyung Chae Kang, Seok Youn Lee, Dong Baek Kang, Seung Ho Kim, Jung Taek Oh, Duk Hwa Choi, Won Cheol Park, Jeong Kyun Lee; J Korean Soc Coloproctol. 2010;26(6):388-394. Published online December 31, 2010; DOI: https://doi.org/10.3393/jksc.2010.26.6.388

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Abstract PDF

Purpose

Recently, single incision laparoscopic surgery (SILS) has been studied for its being less invasive surgery and having cosmetic improvement. We investigated the application of SILS for an appendectomy (SILS-A) in cases of complicated appendicitis and compare it with a conventional laparoscopic appendectomy (C-LA).

Methods

This study involved a total of 40 patients who underwent C-LA or SILS-A in patients with complicated appendicitis; 25 patients received a C-LA, and the other 15 patients received a SILS-A. The clinical outcomes and cosmetic results were compared between the groups.

Results

The SILS-A procedures were performed successfully in patients with complicated appendicitis, but 6 patients who underwent SILS-A needed an additional port for dissection and drainage. Clinical outcomes and postoperative complications were similar in both study groups. The SILS-A group showed significantly higher numbers of pain control than the C-LA group, and the one port SLLS-A group showed significantly better cosmetic result than the C-LA group.

Conclusion

SILS-A is technically feasible and safe in patients with complicated appendicitis. However, SILS-A has more postoperative pain than C-LA, and more active pain control should be considered for patients undergoing SILS-A.

Citations

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Clinical significance of appendicoliths in conservative treatment of acute complicated appendicitis patients with peri-appendiceal abscess: a single-center retrospective study
Lingqiang Min, Jing Lu, Hongyong He
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Single-port laparoscopic appendectomy versus conventional laparoscopic appendectomy for acute appendicitis: a randomized controlled trial
Osama H. Abd-Raboh, Amir F. Abdelhamid, Tarek M. Sehsah
The Egyptian Journal of Surgery.2023; 42(1): 163. CrossRef
Surgical Site Infection Following Single-Port Appendectomy: A Systematic Review of the Literature and Meta-Analysis
Franziska Köhler, Lena Reese, Carolin Kastner, Anne Hendricks, Sophie Müller, Johan F. Lock, Christoph-Thomas Germer, Armin Wiegering
Frontiers in Surgery.2022;[Epub] CrossRef
Comparison of single incision with conventional laparoscopic appendectomy: a retrospective analysis between similarly matched cohort with review of literature
Vipul Prakash Bothara, Mohammed Hamada Takrouney, Bhushan Jadhav, Mohamed Abdelkader Osman, Ibrahim Ali Ibrahim, Almoutaz Ahmed Eltayeb, Gursev Sandlas
Journal of Pediatric Endoscopic Surgery.2021; 3(1): 47. CrossRef
Single-Port Laparoscopic Appendectomy Performing by Emergency Operation: An Intervention Study in Vietnam
Duc Minh Pham, Vu Anh Pham, Mai Tuyet Vi, Linh Van Pham
Trends in Medical Sciences.2021;[Epub] CrossRef
A Comparative Study Between Single-Incision Laparoscopic Appendicectomy Using Conventional Instruments and Glove-Port (SILACIG) and Conventional Multiport Laparoscopic Appendicectomy (CMLA)
Ahamed Muneef, Uday Kumbhar, Chellappa Vijayakumar, Oseen Shaikh
Cureus.2020;[Epub] CrossRef
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Surgical Laparoscopy, Endoscopy & Percutaneous Techniques.2018; 28(5): 291. CrossRef
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Byung Seo Choi, Geon Young Byun, Seong Bae Hwang, Sung Ryul Lee
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Sung Uk Bae, Woon Kyung Jeong, Seong Kyu Baek
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Byung Hee Kang, Kyung Chul Yoon, Sung Woo Jung, Gyeo Ra Lee, Hyung Soon Lee
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Jonas Raakow, Hans-Georg Liesaus, Peter Neuhaus, Roland Raakow
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Lingling Zhao, Zhenqi Liao, Shaoguang Feng, Peng Wu, Guorong Chen
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Case Report

Actinomycosis of the Appendix: A Case Report.: Jee, Sung Bae , Jang, Ki Seok , Kim, Sung Ho , Kim, Chul Joong; J Korean Soc Coloproctol. 2010;26(3):233-237.; DOI: https://doi.org/10.3393/jksc.2010.26.3.233

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Abstract PDF

Actinomycosis is an uncommon disease caused by actinomycoses, which is a normal flora in the human mucosal membrane. It is difficult to diagnose pre- and intra-operatively and requires long-term use of antibiotics even after surgery. Especially, abdominal actinomycosis is frequently misdiagnosed as a tumor, diverticulitis, chronic inflammatory disease, or other infectious disease preoperatively. Thus, we report the case of a 21-yr-old male patient who was thought to have acute appendicitis and who underwent a cecal wedge resection, including the appendix, with the assistance of laparoscopy for appendiceal actinomycosis.

Citations

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Appendiceal actinomycosis mimicking malignant tumor: a rare case report
Nathan Khabyeh-Hasbani, Sivan Zino, Elena Dima, Shmuel Avital
Annals of Medicine & Surgery.2024; 86(2): 1076. CrossRef
Actinomycosis of the Appendix Mimicking Cecal Tumor Treated by Single-Port Laparoscopic Approach
In Soo Cho, Sung Uk Bae, Hye Ra Jung, Kyung Sik Park, Woon Kyung Jeong, Seong Kyu Baek
Annals of Coloproctology.2021; 37(2): 125. CrossRef
A Case of Esophageal Actinomycosis without Treatment in an Immunocompetent Patient
Gyung Eun Kim, Yong-Jun Choi, Jin-Seok Park, Yong Woon Shin, Jee-Young Han
The Korean Journal of Helicobacter and Upper Gastrointestinal Research.2014; 14(1): 67. CrossRef
A Case of Esophageal Actinomycosis in a Patient with Normal Immunity
Hyun Soo Kim, Jong Woon Cheon, Min Su Kim, Chang Kil Jung, Kyung Rok Kim, Jae Won Choi, Dong Woo Kang, Sun Young Kim
The Korean Journal of Gastroenterology.2013; 61(2): 93. CrossRef

Original Articles

Application of a Scoring System to the Diagnosis of Acute Appendicitis.: Kim, June Young , Choi, Seok Ho , Cha, Jin Woo , Byun, Chang Kyu , Koh, Young Taek , Seo, Dong Yup; J Korean Soc Coloproctol. 2010;26(1):34-38.; DOI: https://doi.org/10.3393/jksc.2010.26.1.34

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2 Citations

Abstract PDF

PURPOSE
Acute appendicitis is one of the most common diseases requiring surgical treatment. Delayed diagnosis, which causes complications like perforation of the appendix, abscess formation, or misdiagnosis, leads to unnecessary surgery. Many scoring systems have been suggested for the diagnosis of acute appendicitis. This study aims to evaluate the clinical value of previous scoring systems.
METHODS
This study was conducted with a total of 270 patients who had visited the National Police Hospital (NPH) Emergency Room for acute abdominal symptoms from January to June 2008. The Alvarado and the Ohmann scores were applied retrospectively based on the patients' records. We found 3 criteria which were relatively objective and clinically meaningful; then, we designed a new 10 points scoring system.
RESULTS
The sensitivity and the specificity of the Alvarado scoring system were 83.23% and 64.42%, respectively, whereas those of the Ohmann scoring system were 74.85% and 66.35%, respectively. The sensitivity and the specificity of the NPH scoring system were found to be 78.4% and 68.9%, respectively. The Ohmann scoring system showed a little lower sensitivity, and the NPH scoring system showed a little higher specificity, but the differences were not statistically significant.
CONCLUSION
Our study indicates that the scoring systems considered are not useful diagnostic methods for primary screening and diagnosis of acute appendicitis.

Citations

Citations to this article as recorded by

The Alvarado Score Is the Most Impactful Diagnostic Tool for Appendicitis: A Bibliometric Analysis
Nadir Noureldin Abdella Bahta, Philine Zeinert, Jacob Rosenberg, Siv Fonnes
Journal of Surgical Research.2023; 291: 557. CrossRef
Many diagnostic tools for appendicitis: a scoping review
Nadir Noureldin Abdella Bahta, Jacob Rosenberg, Siv Fonnes
Surgical Endoscopy.2023; 37(5): 3419. CrossRef

Efficacy of a Laparoscopic Appendectomy When Performed by Surgeons Early in Their Laparoscopic Training Courses.: Joo, Kyu Hwa , Son, Byung Ho , Kim, Hyung Ook , Hwang, Sang Il , Kim, HungDai , Han, Won Kon; J Korean Soc Coloproctol. 2010;26(1):17-21.; DOI: https://doi.org/10.3393/jksc.2010.26.1.17

65,535 View
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2 Citations

Abstract PDF

PURPOSE
Laparoscopic surgery has many advantages and has been a popular method for the treatment of various diseases. Although a laparoscopic appendectomy (LA) is now a common practice, it has not yet become the treatment of choice for appendicitis of inexperienced surgeons in their early days of individual laparoscopic training courses. The purpose of this study was to compare the results obtained by inexperienced surgeons to those obtained by experienced surgeons.
METHODS
From May 2007 to January 2008, 130 patients underwent a LA at our department. The surgeries were performed by three surgeons. The patients were divided into 2 groups. In Group I, the LAs were performed by one surgeon who was experienced with laparoscopic procedures, and in Group II, the LAs were performed by two surgeons who were relatively inexperienced with laparoscopic procedures. We retrospectively reviewed patient's medical records for age, sex, previous abdomen operation history, operation method, operation time, surgical complications, length of hospital stay, and the time to resume soft diet.
RESULTS
The age was younger in Group I (29.8+/-18.2 vs. 36.0+/-16.0 yr, P=0.041). The operation time was longer in Group II (48.4+/-28.7 vs. 64.1+/-30.0 min, P=0.003). In Group I, wound infections developed in 4 cases. In Group II, wound infections developed in 7 cases, and an intraabdominal abscess developed in 1 case. The differences in conversion rates, times to start of diet, uses of analgesics, and hospital stays were not statistically significant.
CONCLUSION
Even though an inexperienced surgeon performs the LA for acute appendicitis, there are no differences in postoperative complications and returns to daily activities compared to a LA performed for acute appendicitis by an experienced surgeon. LA is a safe method for the treatment of acute appendicitis for surgeons who are new to laparoscopic procedures.

Citations

Citations to this article as recorded by

Learning curve in laparoscopic appendectomy: training strategy of laparoscopic surgery
Hyung Ook Kim
Annals of Coloproctology.2022; 38(3): 276. CrossRef
A Clinical Comparison of Laparoscopic versus Open Appendectomy for Complicated Appendicitis
Sun Gu Lim, Eun Jung Ahn, Seong Yup Kim, Il Yong Chung, Jong-Min Park, Sei Hyeog Park, Kyoung Woo Choi
Journal of the Korean Society of Coloproctology.2011; 27(6): 293. CrossRef

Case Report

A Case of Acute Appendicitis due to Appendicular Tuberculosis.: Shin, Seong Hwan , Kim, Yong Ho; J Korean Soc Coloproctol. 2009;25(2):117-120.; DOI: https://doi.org/10.3393/jksc.2009.25.2.117

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Abstract PDF: The most common presentation of abdominal tuberculosis is an ileocecal disease, but isolated appendicular involvement is rarely seen. It is difficult to make diagnosis of intestinal tuberculosis because it may mimic many other intestinal diseases. The symptoms are nonspecific such as fever, fatigue and weight loss. A 35-yr-old woman with no remarkable past medical history was admitted due to intermittent abdominal pain of 3 mo duration. The patient underwent laparoscopy-assisted partial ileocecectomy including diseased appendix. Tuberculous appendicitis was finally diagnosed with all considerations of possible pathological results. We report a case of acute appendicitis due to tuberculous involvement with a review of the literature.

Original Article

Abdominal Computed Tomography in Patients with Right Lower Quadrant Pain.: Won, Chang Sik , Roh, Hye Rin , Park, Seung Bae , Kim, Yang Hei , Chae, Gi Bong; J Korean Soc Coloproctol. 2008;24(6):417-421.; DOI: https://doi.org/10.3393/jksc.2008.24.6.417

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Abstract PDF: PURPOSE
This study was performed to evaluate the usefulness of abdominal computed tomography (CT) for patients with right lower quadrant (RLQ) pain.
METHODS
Between January 2006 and July 2008, 191 consecutive patients with RLQ pain underwent abdominal CT (CT group). Forty-two patients who had undergone abdominal ultrasound (US group) and 52 patients without abdominal CT or abdominal ultrasound for RLQ pain (clinical Dx group) underwent emergent operations. Using the Alvarado scoring system, we scored all patients. The abdominal CT was performed in the abdominal and pelvic area with contrast.
RESULTS
One hundred twenty-one (63.4%) of the 191 patients in the CT group were preoperatively diagnosed as having acute appendicitis and underwent surgery. There were three cases of negative appendectomy (1.6%). In the US group and the clinical Dx group, the negative appendectomy rates were 4.8% and 3.8%, respectively. The sensitivity of the abdominal CT was 96.7%. In the CT group, in addition to acute appendicitis, colitis, nonspecific enteritis, diverticulitis, urinary stone, ovary, uterine, and diseases were indentified.
CONCLUSIONS
In this study, abdominal CT scans in patients with RLQ pain were useful for the diagnosis acute appendicitis and for the differential diagnosis of other diseases presenting with RLQ pain. The false positive rate was significantly lower in the CT group than in the other groups.

Case Report

Acute Perforated Appendicitis in a Patient with Nonrotation of the Midgut: A Case Report.: Park, Seong Jun , Ju, Young Tae , Jeong, Chi Young , Jung, Eun Jung , Lee, Young Joon , Hong, Soon Chan , Ha, Woo Song , Park, Soon Tae , Choi, Sang Kyung; J Korean Soc Coloproctol. 2008;24(3):219-222.; DOI: https://doi.org/10.3393/jksc.2008.24.3.219

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Abstract PDF: The presence of a malrotation of the midgut in adults is identified in asymptomatic patients most commonly as an incidental finding during a workup for an unrelated disease. We report here a rare case of acute perforated appendicitis in a patient with nonrotation of the midgut. A 28-year-old man was referred to our hospital with lower abdominal pain. The radiological examination, including abdominal computed tomography, ultrasonography, an upper gastrointestinal series, and a barium enema, revealed acute perforated appendicitis accompanied by nonrotation of the midgut. Emergency surgery revealed a complicated appendix located in the middle area of the lower abdomen with a periappendiceal abscess and nonrotation of the midgut. An ileocecal resection was performed with no postoperative complication. In this case, the atypical position of the appendix led to confusion regarding the diagnosis and to a more invasive surgical intervention.

Original Articles

Laparoscopic vs. Conventional Appendectomy in Pregnancy.: Kim, Do Hyoung , Lee, In Kyu , Choi, Seung Bong , Lee, Yoon Suk , Lee, Sang Kuon , Oh, Seong Taek , Jeon, Hae Myung , Kim, Jun Gi , Kim, Eung Kook , Chang, Suk Kyun; J Korean Soc Coloproctol. 2008;24(3):161-165.; DOI: https://doi.org/10.3393/jksc.2008.24.3.161

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Abstract PDF

PURPOSE
The purpose of this study was to evaluate the clinical course and pregnancy outcome according to operative management of appendictis in the Department of Surgery.
METHODS
We reviewed the charts of pregnant patients who went through a convential appendectomy and a laparoscopic appendectomy at the Department of Surgery, Catholic University of Korea St. Mary's Hospital, from May 1995 to June 2006. RESULTS: The incidence of acute appendicitis during pregnancy was the highest at the 2nd trimester and at ages from 25 to 30 years. The laparoscopic appendectomy was shorter than the open appendectomy in hospital stay and decreased leukocytosis faster in the first postoperative day, except in cases of perforated appendicitis, but the operation times were similar. There was a significant difference in gestational age at delivery between perforated appendicitis and suppurative. We found one fetal anomaly, but it was not related to either the appendicitis or the operation method. CONCLUSIONS: In this study, we found that a laparoscopic appendectomy was better than an open appendectomy for recovery and was safe in pregnant appendicitis patients at any gestational age. However, follow up and investigation in a larger population is needed to get more accurate results.

Citations

Citations to this article as recorded by

Appendicitis during Pregnancy: The Clinical Experience of a Secondary Hospital
Soo Jung Jung, Do Kyung Lee, Jun Hyun Kim, Pil Sung Kong, Kyung Ha Kim, Sung Woo Bae
Journal of the Korean Society of Coloproctology.2012; 28(3): 152. CrossRef

The Efficacy of the Alvarado Score in the Diagnosis of Acute Appendicitis.: Lee, Sung Min , Chang, In Taik , Kim, Beom Gyu , Cha, Sung Jae , Kim, Yong Seok , Pak, Jun Seok; J Korean Soc Coloproctol. 2008;24(1):1-6.; DOI: https://doi.org/10.3393/jksc.2008.24.1.1

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Abstract PDF

PURPOSE
Acute appendicitis is the most common cause of an acute abdomen that needs an emergency operation. However, the preoperative diagnosis is difficult. The purpose of this study is to assess the diagnostic efficacy of the Alvarado score by a comparison with CT and to determine the indication of CT evaluation. METHODS: From August 2006 to October 2006, 111 consecutive patients were admitted to Chung-Ang University hospital under the impression of acute appendicitis, and a CT scan was done. The Alvarado score, which consists of migration, anorexia, nausea-vomitig, tenderness, rebound tenderness, fever, leukocytosis, and left shift, was applied to the patients. RESULTS: Of the 111 patients, 85 patients underwent an operation, and 26 were discharged without an operation on the basis of the CT finding. The negative appendectomy rate were 4.7%. CT showed a sensitivity, of 0.90 a specificity of 0.97 and an accuracy rate of 0.92. Tenderness and leukocytosis were confirmed as the most important tests and showed accuracy rates of 0.73 and 0.70, respectively. The sensitivity was 0.90 at score 5 and 0.85 at score 7. Therefore, there was no single cut-off score that satisfied all diagnostic values. CONCLUSIONS: The Alvarado score alone is not a satisfactory diagnostic method acute appendicitis. Of the appendicitis patients, 90% might be included in the diagnosis for Alvarado scores above 5, and the negative appendectomy could be as high as 15% for Alvarado scores above 7, which is the score generally accepted for a diagnosis of appendicitis.

Citations

Citations to this article as recorded by

Ultrasonography of Appendicitis
Dae Hyun Kim
Clinical Ultrasound.2016; 1(1): 19. CrossRef
Diagnostic Efficacy of the Alvarado Score according to Age in Acute Appendicitis
Bo-Young Oh, Kwang-Ho Kim, Ryung-Ah Lee, Soon Sup Chung
Journal of the Korean Surgical Society.2010; 78(2): 100. CrossRef

Clinical Analysis of Appendicitis in the Elderly Over 60 Years of Age.: Kim, Il Gun , Heo, Tae Gil , Lee, Jung Min , Choi, Pyong Wha , Park, Je Hoon , Lee, Myung Soo , Kim, Chul Nam , Chang, Surk Hyo; J Korean Soc Coloproctol. 2007;23(6):441-447.; DOI: https://doi.org/10.3393/jksc.2007.23.6.441

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Abstract PDF

PURPOSE
As average life expectancies are prolonged, the elderly population is steadily increasing. The increasing number of elderly persons has been accompanied by cases of acute appendicitis in the elderly. In order to understand the clinical significance and to improve the treatment of elderly patients with appendicitis. we analyzed patients over 60 years of age with appendicitis.
METHODS
We retrospectively reviewed the medical records of 268 patients over 60 years of age who were pathologically diagnosed with appendicitis. We analyzed the patients' clinicopathologic factors and outcomes, dividing them into 3 age groups: 60~69, 70~79, 80 and over.
RESULTS
Of the 268 patients, there were 109 male and 159 female. The sex ratio was 1:1.46. The numbers of patients in each group were 169 (63.1%) in the 60-69 group, 73 (27.2%) in the 70~79 group, and 26 (9.7%) in the over 80 group. There was no difference in the leukocyte count and the time delay in surgical treatment between the groups. In the older groups, compared to the younger groups, there were more frequent paramedian and median incisions in the operation (P=0.02), a longer duration of postoperative admission (P=0.001) and starvation after the operation (P<0.001). In the pathologic findings, the gangrenous and abscess stages of appendicitis were more frequent in the older groups than in the younger groups (P<0.001).
CONCLUSIONS
Early aggressive diagnostic intervention, such as ultrasound and CT, is essential in managing appendicitis in elderly patients who complain of vague abdominal pain.

Citations

Citations to this article as recorded by

Ultrasonography of Appendicitis
Dae Hyun Kim
Clinical Ultrasound.2016; 1(1): 19. CrossRef

A Clinical Study of Acute Appendicitis in Pregnancy.: Jang, Yong Seog; J Korean Soc Coloproctol. 1998;14(4):767-774.

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Abstract PDF: PURPOSE
Acute appendicitis is the most frequently encountering extrauterine surgical condition in pregnancy. Prompt diagnosis of acute appendicitis in pregnancy is not easy on the basis of clinlical findings, which may be obscured or altered by the presence of a gravid uterus. In most of cases, prompt diagnosis and early surgical intervention could result in optimal maternal and fetal outcomes. MATERIAL AND METHODS: We performed retrospective analysis of 20 cases, which were operated under the diagnosis of acute appendicitis in pregnancy from 1990 to 1995 at the department of surgery, Soonchunhyang University Hospital.
RESULTS
1) The incidence of the acute appendicitis in pregnancy was one per 742 deliveries and the diagnostic accuracy was 85%. 2) The majority of patiens was in the 3rd decade of age (76.5%). 3) Gestational stages at onset of symptom were first trimester in 6 patients (35.3%) and second trimester (52.9%) in most patients. 4) The majority of patients(82.4%) spent less than 24 hours preoperatively. 5) The symptoms in order of frequency were; abdominal pain (100%), nausea (70.5%), vomiting (41.1%), fever (23.5%), chill (11.8%), constipation (11.8%), diarrhea (5.9%). The maximal tenderness was noted on McBurney's point (29.4%) and above McBurney's point (58.8%) in most of patient. 6) The leukocyte counts were mostly in the range of 10,000 to 15,000 mm3 (47.1%) and 15,000 to 20,000 mm3 (35.3%). 7) Several types of incisions were employed: a McBurney incision was used in 8 cases (47.1%), a transverse incision in 8 cases (47.1%), and a low midline incision in 1 case (5.8%). A general anesthesia was done in 6 patients (35.3%), a spinal anesthesia done in 8 patients (47.1%), and an epidural anesthesia done in 3 patients (17.6%). A drain was placed intraabdominally in 2 cases. 8) Among 17 cases, three were reported as focal appendicitis (17.6%), ten as suppurative one (58.8%), one as ganagrenous one (5.9%) and three as perforated one (17.6%). 9) The postoperative complications included 1 wound infection and 4 artificial abortions. There was no maternal death, preterm labor, or spontaneous abortion.
CONCLUSION
Despite of diagnostic obstacles due to pregnancy, acute appendicitis can be diagnosed without major difficulty. High index of suspicion is required during diagnostic procedures and prompt surgical intervention improves maternal and fetal outcomes...EABS:

Case Report

Idiopathic Granulomatous Appendicitis: A case report.: Park, In Hyung , Kim, Woo Jin , Han, Min Suk , Kim, Soo Hang , Sun, Jae Hyung , Park, Jin Suk , Park, Jae Hong , Lee, Soong , Lee, Woong , Kim, Sun Phil; J Korean Soc Coloproctol. 2006;22(5):337-340.

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Abstract PDF: Crohn's disease is a chronic condition characterized by a non-specific granulomatous necrosis involving potentially any location in the alimentary tract, but a primary lesion confined to the appendix alone is very rare. It is difficult to discriminate Crohn's appendicitis from acute appendicitis preoperatively because of their clinical similarities. Because Crohn's disease confined to the appendix has a more favorable prognosis than typical Crohn's disease, it is considered a separate disease from Crohn's disease. Recently, the term idiopathic granulomatous appendicitis has gained wide acceptance as a distinct disease entity. We experienced a case of Crohn's disease giving rise to appendicitis or idiopathic granulomatous appendicitis and report a case with a review of the literature.

Original Articles

Clinical Analysis of Acute Appendicitis in the Elderly.: An, Sang Su , Soh, Yoon Seop , Cho, Ik Haeng , Back, Hyeon Myeong , Lee, Seong Yeol; J Korean Soc Coloproctol. 2002;18(5):274-280.

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Abstract PDF: PURPOSE
Surgeons are confronted frequently with the diagnostic and therapeutic challenges in the cases of acute appendicitis in the elderly. Despite the improvements in management, the morbidity and mortality remain high. In order to verify contributing factors of high morbidity and mortality and establish more proper diagnostic and therapeutic strategies, we compared the clinical characteristics and outcomes of acute appendicitis in the elderly with those of younger people.
METHODS
We retrospectively reviewed medical records of 30 elderly and 248 younger people who were pathologically diagnosed as appendicitis after an appendectomy.
RESULTS
There was no difference in the rates of occurrence of right lower abdominal pain and tenderness between the two people. The rate of appendiceal perforation was significantly higher in the elderly. Prehospital delay was significantly longer in the elderly. Concomitant diseases were more prevalent in the elderly. The hospital stay was significantly longer and the rate of complication was relatively higher in the elderly also.
CONCLUSIONS
When a vague and unexplained abdominal discomfort occurs in the elderly, we should suspect and rule out acute appendicitis as the cause of the discomfort. Early aggressive diagnostic and therapeutic interventions are essential components in managing acute appendicitis in the elderly. In addition, perioperative evaluation and prophylactic measures for concomitant diseases are needed to decrease morbidity and mortality in the elderly.

Application of the Alvarado Score to the Diagnosis of Acute Appendicitis.: Kim, Hea Eun , Park, Sung Bae , Woo, Sang Uk , Rho, Hye Rin , Chae, Gi Bong , Choi, Won Jin; J Korean Soc Coloproctol. 2006;22(4):229-234.

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Abstract PDF: PURPOSE
The purpose of this study is to confirm the clinical usefulness of the Alvarado score's application and the differences in diagnostic values between male and female for patients who were diagnosed with acute appendicitis when they came to the hospital for pain in the right lower abdomen.
METHODS
The subjects of this study were 211 patients who entered the surgical department of this hospital for doubtful acute appendicitis from June 2003 to May 2005. Using a retrospective method, we examined the patients' records and compared their ages, sex, symptoms, preoperative physical examinations, leukocyte and neutrophils figures, and the final postoperative pathological diagnosis.
RESULTS
One hundred twelve patients were male, and 99 were female. A clinical Alvarado score of above 7 in sensitivity, specificity, positive predictive value, and negative predictive value was the standard for being judged positive. In this study, the sensitivity of the Alvarado score was 86.2%, its specificity was 61.6%, and the accuracy of diagnosis was 82.9%. The positive predictive value was 92.6%, and the negative predictive value was 51.0%. The accuracies were 83.9% and 81.8%, respectively, that for males being a little higher than that for female, but with no statistically significant differences.
CONCLUSIONS
This study showed that the diagnosis of acute appendicitis was highly accurate for an Alvarado score above 7 (82.9%). The diagnosis of acute appendicitis by using the Alvarado score is simple, fast, reliable, and repeatable, and it can be used under any conditions without other expensive and complicated diagnostic tools.

Impact of Physician Delay on Postoperative Outcome of Patients with Acute Appendicitis.: Cho, Byeong Wook , Park, Seong Heum , Yoon, Seo Gue , Choi, Kyong Woo; J Korean Soc Coloproctol. 1998;14(3):561-568.

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Abstract PDF: BACKGROUND
It is controversial whether the delay of surgery for acute appendicitis by physician results in higher morbidity. Our present study explores this problem of physician delay on the postoperative outcome of patients with acute appendicitis. MATERIAL AND METHODS: Among 432 patients admitted for the presumptive diagnosis of acute appendicitis between Jan., 1995 and Dec., 1997, 358 patients with pathologically proven acute appendicits were analyzed. Physician delay from the hospital admission to the surgery was evaluated in relation to the stage of the disease at operation and postoperative outcome.
RESULTS
Postoperative complications occurred signifficantly higher in advanced appendicitis group, than in simple appendicitis group. Postoperative oral consumption started significantly later and hospital days are significantly prolonged in those group. Both patient and physician delays significantly affect the stage of the disease. The finding that physician delay correlated with the stage, however, was denied by multivariate analysis.
CONCLUSION
On the contrary to the patient delay, physician delay does not affect the stage of the acute appendicitis nor lead to increased incidence of postoperative complication. Physician delay to clarify the diagnosis is a reasonable strategy and it does not affect the outcome adversely.

Clinical Evaluation of Laparoscopic Appendectomy.: Lee, Min Hwa , Song, Byung Joo , Choi, Sang Yong , Park, Sin Hee , Kim, Chin Seung; J Korean Soc Coloproctol. 1998;14(3):551-560.

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Abstract PDF: BACKGROUND
This study was performed to evaluate our experience on laparoscopic appendectomy.
METHODS
Retrospective analysis was performed on 2,856 patients who had been operated by laparoscopic appendectomy under diagnosis of acute appendicitis at the Sung-Ae Hospital and Kwang-Myoung Sung-Ae Hospital from October 1991 to July 1998.
RESULTS
Among 2,856 patients who had undergone laparoscopic appendectomy,2,379 patients (83.3%) were operated due to simple acute appendicitis, 275 patients (9.6%) due to perforated appendicitis. Operation time was 44.6 minutes for simple acute appendicitis and 60.3 minutes for perforated appendicitis. In perforated appendicitis, intra-peritoneal irrigation and drain insertion was performed. The length of hospital stay in patient with simple acute appendicitis was 3.7 days (5.82 days in conventional appendectomy) and patients with perfotrated appendicitis was 6.1 days (9.91 days in conventional appen-dectomy). Complications such as wound infection, intra-abdomen abscess, trocar site bleeding, subcutaneous emphysema developed in 43 (1.5%) patients (79/1,947, 4.5% in conventional appendectomy). In 202 (7.1%) patients, appendix was normal, but another diseases were detected, including acute pelvic inflammation, ovarian cyst, mesenteric lymphadenitis, enteritis, diverticulitis in order.
CONCLUSION
Overall complication rate was lower in laparoscopic appendectomy compared with conventional appendectomy and the length of hospitalization of laparoscopic appendectomy was shorter. When the acute appendicitis is suspected, especially in the reproductive women, the laparoscopic approach would be better diagnostic and therapeutic value than conventional method. Therefore laparoscopic appendectomy would be replaced with conventional appendectomy.

Clinical Usefulness of Laparoscopic Appendectomy.: Shin, Jun Ho , Park, Yong Kai , Kim, Heung Dae; J Korean Soc Coloproctol. 1998;14(3):541-550.

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Abstract PDF: PURPOSE
There have been numerous retrospective and uncontrolled study of laparoscopic appendectomy. Although most of these have concluded that the laparoscopic appendectomy is at least as good as open appendectomy, there has been considerable controversy as to whether laparoscopic appendectomy is superior.
METHODS
We performed total 47 cases of laparoscopic appendectomy (LA) during one year from January 1997 to December 1997 and these were compared with 50 cases of open appendectomy (OA) in same period to assess the clinical usefulness.
RESULTS
The sex, male to female ratio and severity of appendicitis were similar in both groups. The anesthetic time was longer in the LA group (P<0.05) but operative time was similar. Gas-passing time and diet-intake time in postoperative period were earlier in LA group (P<0.05). The LA group required less analgesics in postoperative period. In LA group, no case was converted to open appendectomy and overall complication rate was lower in LA group but this was not statistically significant. Among the postoperative complication, the wound infection rate was absolutely lower in LA group (P<0.05). The diagnostic rate for acute abdomen including acute appendicitis was superior in LA group, especially in reproductive women. The hospital stay was shorter in LA group (P<0.05) and hospital charges was not different in both group.
CONCLUSION
Laparoscopic appendectomy offers considerable advantages over open appendectomy because this has ability to reduce postoperative complications and shorten recovery times and is useful for detecting the cause of acute abdomen other than acute appendicitis. So we expect this technique will be alternative operation or new standard operation in selected cases for suggestive acute appendicitis.

The Role of Computed Tomography in the Diagnosis of Acute Appendicitis.: Choi, In Seok , Yea, Byung Kook , Han, Gun Taek , Sim, Mun Sup; J Korean Soc Coloproctol. 2002;18(3):178-183.

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Abstract PDF: PURPOSE
Appendicitis represents one of the most common surgical disorders. Typically, the diagnosis can be made from well established clinical criteria, with an acceptable negative appendectomy rate from 7~25%. However, when surgical intervention is performed in the patients suspected of having appendicitis but with equivocal clinical findings, the negative appendectomy rate approaches 50%. Routine contrast-enhanced computed tomography (CECT) has described as an accurate diagnostic imaging modality in patients with suspected appendicitis. We evaluated the role of intravenous CECT (iCECT) in patients suspected of having appendicitis but with equivocal clinical exams.
METHODS
Eighty seven consecutive patients who were thought to have appendicitis but with equivocal clinical findings and/or physical exams were imaged by iCECT over 18 months period. Intravenous contrast-enhanced, spiral abdominal and pelvic images were obtained using 7.5 mm cuts. iCECT images were interpreted by a board-certified radiologist. Main outcome measures included iCECT sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), accurary and negative appendectomy rate in the diagnosis of acute appendicitis, and determining the impact iCECT on the clinical management of the patient population.
RESULTS
A group of 87 patients consisting of 36 males (41.4 %) and 51 females (58.6%) with median age of 32 years (range 12 to 75 years) were imaged with iCECT to evaluate suspected appendicitis. Of the 87 iCECTs performed, 8 false-positive and 2 false-negative readings were identified, resulting in a sensitivity of 93.5%, specificity of 85.7%, PPV of 78.4%, NPV of 96%, and an overall accuracy of 88.5%. With regard to clinical management, 100% (31/31) of patients with appendicitis, and 4% (2/50) of patients without appendicitis underwent appendectomy. Therefore, the overall negative appendectomy rate was 6.1% (2/33).
CONCLUSION
iCECT is a useful diagnostic imaging modality for patients suspected of having acute appendicitis but with equivocal clinical findings and/or physical exams. iCECT is particularly useful in excluding the diagnosis of appendicitis in those without disease.

Case Reports

A Case of Acute Appendicitis Associated with Enterobius Vermicularis.: Kim, Do Hyoung , Cheon, Joon Sung , Kim, Jeong Goo , Lee, Dong Ho , You, Young Kyoung , Lee, Hye Kyung , Ahn, Chang Joon; J Korean Soc Coloproctol. 2006;22(1):54-57.

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Abstract PDF: Enterobius vermicularis is one of the common parasites in the world. The infestation rate of Enterobius vermicularis is higher in children than in adults. Moreover, the egg-positive rate of Enterobius vermicularis is higher in the mentally retarded population. We report the case of a ten-year-old, mentally retarded boy, who was diagnosed as having acute appendicitis associated with Enterobius vermicularis.

Isolated Crohn's Disease of Appendix: Is It Crohn's Disease or Idiopathic Granulomatous Appendicitis? Report of a case and review of the literature.: Kim, Min Young , Bong, Jin Gu , Lee, Sang Yeop; J Korean Soc Coloproctol. 1998;14(2):309-316.

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Abstract PDF: A case of isolated Crohn's disease of appendix is reported. It is a rare disease which commonly mimics the symptoms of acute appendicitis. Review of 221 identical cases previously reported in the world literature revealed slight male predominance(1.17:1) and peak age of incidence in the third decade(24.3 yrs). In contrast to typical Crohn's disease, the rate of postoperative fistula and recurrence was minimal; 1.0% and 3.8%, respectively. Due to these differences, many consider it to be a separate disease entity from Crohn, and a new diagnostic term - "Idiopathic Granulomatous Appendicitis" - has gained wide acceptance in recent years.

Original Article

Clinical Analysis of 42 Cases Who Underwent Colectomy for Suspected Acute Appendicitis.: Yoon, Ho Young , Kim, Byung Chun; J Korean Soc Coloproctol. 2005;21(6):357-361.

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Abstract PDF: PURPOSE
When patients underwent emergency surgery for suspected appendicitis, colon resection could be performed at the time of the initial operation. The aim of this study was to evaluate 42 cases underwent colectomy for suspected acute appendicitis.
METHODS
A retrospective analysis of 42 patients underwent colectomy for suspected acute appendicitis was performed over the period from January 1997 to December 2003 at the department of surgery, Kangnam Sacred Heart hospital, Hallym university.
RESULTS
The sex ratio were 1.2:1. The mean age was 37.7 years. Right lower quadrant pain was present in all patients. Nausea and vomiting occurred in 18 cases (42.8%). Preoperative fever was 11 cases (26.1%). Abdominal ultrasound was most commonly performed preoperatively. The operative findings showed cecal mass with pericecal abscess was 20 cases (47.5%) and cecal mass with inflammation, 11 cases (26.1%), etc. The pathologic findings showed cecal diverticular abscess was 18 cases (42.8%) and pericecal abscess, 9 cases (21.4%), periappendiceal abscess, 5 cases (11.9%), etc. Type of operation was ileocecectomy, 29 cases (69.04%), and right hemicolectomy, 12 cases (28.57%), and extended right hemicolectomy, 1 case. Postoperative complications developed in 12 cases (28.57%), but those were uneventful.
CONCLUSIONS
When an unexpected and suspicious cecal mass was found at operation for suspected appendicitis, the resection of all clinically apparent disease including colectomy could be considered. So, the surgeon must be aware of the possibility of these condition and choose the appropriate treatment.

Case Report

Laparoscopic Appendectomy for Acute Appendicitis Caused by Enterobius Vermicularis.: Lee, Yoon suk , Lee, In kyu , Oh, Seung teak , Kim, Jun gi , Jang, Suk kyun , Kim, Young ha , Kim, Kyung Mee; J Korean Soc Coloproctol. 2005;21(4):255-257.

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Abstract PDF: Enterobius vermicularis (pinworm) infection occurs in 4~28% worldwide. Although the most common clinical manifestation is perianal pruritis, it may cause gastrointestinal manifestations, including acute appendicitis in about 0.2~41.8% of infections. Preoperative diagnosis of pinworms in patients with acute appendicitis is not routinely performed. We performed a laparoscopic appendectomy for an acute appendicitis caused by Enterobius vermicularis. To our knowledge, this is the first report of a laparoscopic appendectomy for acute appendicitis caused by Enterobius vermicularis in Korea.

Original Articles

Difference in Clinical Features between Appendicitis and Right-Sided Colonic Diverticulitis on Initial Diagnosis.: Lee, Eun Kyu , Kim, Hungdai , Son, Beong Ho , Han, Won Kon; J Korean Soc Coloproctol. 2005;21(4):201-206.

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Abstract PDF: PURPOSE
Most patients who are finally diagnosed as having cecal and right-sided colonic diverticulitis complain of pain in the right lower quadrant of the abdomen, many of them unfortunately undergo an emergency operation for presumed appendicitis. Our purpose was to differentiate the diagnosis of right-sided colonic diverticulitis from appendicitis in an emergency setting.
METHODS
We retrospectively reviewed the medical records of 450 patients between January 1997 and July 2003. Among them, 92 patients who had been diagnosed as having right-sided colonic diverticulitis were classified as Group I. In the remaining 358 patients with appendicitis, 268 patients with simple appendicitis were classified as Group II and 90 patients with perforated appendicitis were classified as Group III.
RESULTS
The sex ratios were similar among 3 groups. The mean age of Group I (36.5+/-10.1 years) was significantly different from that of Group II (30.7+/-14.8 years, P=0.002), but not from that of Group III (38.7+/-20.9). Incidences of fever/chill and nausea/vomiting were less common in Group I (P<0.05). The duration of prodromal symptoms in Group I (2.6 days) was longer than that of Group II (1.6 days, P=0.02), but was not significantly different from that of Group III (3.3 days, P=0.83). The mean WBC count was significantly smaller in Group I (10913.8/mm3) than in Group II (13238.3/mm3) and III (15589.3/mm3, P<0.001). The percentage of segment form in differential counts was smaller in Group I (73.6%) than in Group II (79.1%) and III (81.8%, P<0.001). The percentage of lymphocytes in differential counts was larger in Group I (17.7%) than in Group II (13.9%) and Group III (9.4%, P<0.001).
CONCLUSIONS
Among the patients who complain of pain in the right lower quadrant abdomen in an emergency setting, cecum and right-sided colonic diverticulitis must be considered in the following conditions to avoid unnecessary emergency operations, relatively younger patients (20~40 years), infrequent prodromal symptoms, absent rebound tenderness with a laterally deviated maximal tenderness point, and absent or mild leucocytosis with a relatively low fraction of segment forms associated with a higher fraction of lymphocytes in CBC.

Diagnostic Laparoscopy through a Right Lower Abdominal Incision in Suspected.: Suh, Hae Hyeon; J Korean Soc Coloproctol. 1997;13(4):611-618.

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Abstract PDF: Recently, diagnostic laparoscopy has proved useful in reproductive women and patients with suspicious appendicitis. Diagnostic laparoscopy is usually performed through an incision just above or below the umbilicus. But the periumbilical incision of laparoscopy sometimes causes unnecessary skin incision when converted to open conventional appendicectomy and incisional hernia through the periumbilical port site. To prevent these disadvantages I have performed diagnostic laparoscopy through a right lower abdominal incision in suspected appendicitis. A transverse skin incision of 1.5~2.0 cm in length is made in the right lower abdomen. Using the open method, a cannula is inserted into the peritoneal cavity. After establishing the pneumoperitoneum, the whole peritoneal cavity can be carefully observed by tilting the operation table. According to the laparoscopic findings, appendicectomy and/or other operations may be performed with the laparoscopic or conventional method. I have used this technique in 39 patients (17 men and 22 women; age range 6 to 69 years). Pathologic findings of removed appendices were 2 normal; 17 catarrhal; 13 suppurative; and 7 gangrenous. The appendix was not visualized in 4 patients; but, were diagnosed to be appendicitis according to the findings of neighboring structures. There was a false negative which was a focal appendicitis accompanied with salphingitis. But there was no false positive. Associated diseases were gall stone (3 cases), uterine myoma (2 cases), an inguinal hernia, an intestinal adhesion, an ulcerative colitis, and a Crohn's disease. In conclusion, this technique can be an alternative route when the periumbilical route is difficult to approach due to previous incisional scars. Compared to periumbilical laparoscopy: (1) it is technically easier because it is familiar to the general surgeon; (2) it is more effective for esthetic purposes because it does not leave an unnecessary skin incision; and (3) it can prevent incisional hemia.

Abdominal Sonography of Suspected Appendicitis.: Sim, Won Sup , Sim, Myungsuk; J Korean Soc Coloproctol. 2001;17(2):59-63.

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Abstract PDF: PURPOSE
To decrease the high negative appendectomy rate, in addition to the traditional history-taking, physical examination, and laboratory findings, additional sensitive and specific examinations are necessary. The authors conducted a study to evaluate the value of ultrasonographic examination in the diagnosis of acute appendicitis in patients with clinically suspected appendicitis.
METHODS
During 18 months from July 1, 1998 through December 31, 1999, a total of 290 patients were enrolled into the study. Altogether 110 abdominal sonographic examinations were performed by the staff radiologist, in all cases of clinically suspected appendicitis. The improvement of diagnostic accuracy was compared with the historical control group of 240 patients during the period of 18 months from January 1, 1997 through June 30, 1998.
RESULTS
Clinical diagnosis (without sonographic examination) was made in 180 patients (157 appendicitis, and 23 non-appendicitis). Negative appendectomy was performed in 24 patients. Sonographic diagnosis was made in 110 patients with clinically suspected appendicitis (91 appendicitis, and 19 non-appendicitis). Negative appendectomy was done in 9 patients. Nineteen patients without positive sonographic findings of appendicitis could be spared the negative appendectomy. Abdominal sonography for detecting acute appendicitis had a sensitivity of 100.0%, a specificity of 67.9%, an accuracy of 91.0%, a positive predictive value of 90.1%, and a negative predictive value of 100.0%. By adding ultrasonographic examinations in all cases of clinically suspected appendicitis, diagnostic specificity was increased significantly over the historical control group (P<0.01).
CONCLUSIONS
Although the value of meticulous history- taking, physical examination, and laboratory tests cannot be overemphasized, our experience suggests that patients with clinically suspected appendicitis should routinely undergo abdominal sonographic examinations, performed by experienced radiologists and surgeons, to further decrease the negative appendectomy rates.

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