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Update on the Diagnosis and Treatment of Appendicitis
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Update on the Diagnosis and Treatment of Appendicitis

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Gastroenterology & Hepatopancreatobiliary Medicine".

Deadline for manuscript submissions: 30 June 2024 | Viewed by 4025

Special Issue Editors

Prof. Dr. George Vaos

E-Mail Website
Guest Editor
Department of Pediatric Surgery, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
Interests: neonatal surgery; pediatric gastrointestinal surgery; pediatric thoracic surgery; pediatric urology
Prof. Dr. Nikolaos Zavras

E-Mail Website
Guest Editor
Department of Pediatric Surgery, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
Interests: pediatric laparoscopic surgery; bariatric surgery; oncology

Special Issue Information

Dear Colleagues,

Appendicitis is one of the most common abdominal surgical emergencies in adults and children in the world, with a lifetime risk of 8.6% in males and 6.7% in females. The diagnosis of appendicitis is always a challenge. Delays in presenting to the physician and further delays in proper treatment due to misdiagnosis can increase the possibility of complications, especially in children. Although diagnosis is primarily clinical, the utilization of imaging and different scores can stratify patients in low, moderate, or high-risk groups and help in making a timely diagnosis. In patients at moderate to high-risk, surgical consultation should be conducted promptly to reduce morbidity and mortality resulting from the perforation of the appendix. Some controversies over strategies for treating appendicitis have been generated without a complete consensus. Laparoscopic or open appendicectomy is the standard treatment of appendicitis. However, some patients with perforated appendicitis may benefit from immediate surgery or initial antibiotic treatment, followed by interval appendicectomy, and several studies have even suggested a non-operative treatment with antibiotics alone in selected cases. The purpose of this Special Issue is to provide an update on the critical debates regarding the above aspects of appendicitis, and to discuss recent controversies in the field. Original articles, systematic reviews, meta-analyses and short communications on the topics described above are welcome. We also invite relevant basic, translational and clinical research.

Prof. Dr. George Vaos
Prof. Dr. Nikolaos Zavras
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Clinical Medicine is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • appendicitis
  • complicated appendicitis
  • imaging in appendicitis
  • scoring in appendicitis
  • laparoscopic appendicectomy
  • open appendicectomy
  • conservative treatment of appendicitis
  • controversies in diagnosis
  • controversies in treatment

Published Papers (4 papers)

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Research

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11 pages, 925 KiB  
Article
Management and Incidence of Enterobius vermicularis Infestation in Appendectomy Specimens: A Cross-Sectional Study of 6359 Appendectomies
by Zenon Pogorelić, Vlade Babić, Marko Bašković, Vladimir Ercegović and Ivana Mrklić
J. Clin. Med. 2024, 13(11), 3198; https://doi.org/10.3390/jcm13113198 - 29 May 2024
Viewed by 281
Abstract
Background: The role of Enterobius vermicularis infestation in the context of appendicitis is largely overlooked, but Enterobius vermicularis is considered an unexpected and significant appendicectomy finding. The aim of this study was to investigate the frequency of Enterobius vermicularis findings in appendectomies and [...] Read more.
Background: The role of Enterobius vermicularis infestation in the context of appendicitis is largely overlooked, but Enterobius vermicularis is considered an unexpected and significant appendicectomy finding. The aim of this study was to investigate the frequency of Enterobius vermicularis findings in appendectomies and to evaluate the clinical and histopathologic features of patients with Enterobius vermicularis-associated acute appendicitis and those with appendiceal Enterobius vermicularis infestation. Methods: The medical records of all children who underwent an appendectomy in two large pediatric centers in Croatia between 1 January 2009 and 1 January 2024 were retrospectively reviewed. Of 6359 appendectomies, 61 (0.96%) children were diagnosed with Enterobius vermicularis on histopathology and included in further analysis. The groups were compared with regard to demographic characteristics, laboratory values, clinical features and histopathological findings. Results: The incidence of enterobiasis fluctuated slightly in the individual study years, but was constant overall. The median age of all patients was 11 years (IQR 8.5, 13), with females predominating (60.7%). Acute appendicitis was observed in 34% of the appendiceal species. The patients with Enterobius vermicularis infestation, without appendicitis, were younger (9 years (IQR 8, 13) vs. 12 years (IQR 10, 15); p = 0.020), had longer duration of symptoms (36 h (IQR, 12, 48) vs. 24 h (IQR, 12, 36); p = 0.034), lower body temperature (37 °C (IQR 36.8, 37.4) vs. 37.6 °C (IQR, 37, 38.6) p = 0.012), lower Appendicitis Inflammation Response (AIR) score (3 (IQR 2, 5) vs. 7 (IQR 5, 9.5) p < 0.001), lower incidence of rebound tenderness (57.1% vs. 20%; p = 0.003) and less frequent vomiting (12.5% vs. 47.6%; p = 0.004) compared to the patients with Enterobius vermicularis-associated acute appendicitis. Acute inflammatory markers in the laboratory showed significantly higher values in the group of patients with acute appendicitis: C-reactive protein (p = 0.009), White blood cells (p = 0.001) and neutrophils (p < 0.001). Eosinophilia was not found in any of the groups, although eosinophil counts were significantly higher in children who had Enterobius vermicularis infestation than in those with Enterobius vermicularis-related appendicitis (2.5% (IQR 0.9, 4.3) vs. 1.8% (IQR 0.7, 2.1); p = 0.040). Conclusions: Pediatric surgeons should consider Enterobius vermicularis infestation as a differential diagnosis when removing a vermiform appendix. Younger age, longer duration of symptoms, lower body temperature, lower AIR score, lower diameter of the appendix and normal laboratory inflammatory markers could predict Enterobius vermicularis infection in children presenting with right iliac fossa pain and avoid unnecessary appendectomy. Full article
(This article belongs to the Special Issue Update on the Diagnosis and Treatment of Appendicitis)
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Review

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13 pages, 280 KiB  
Review
Controversies and Future Directions in Management of Acute Appendicitis: An Updated Comprehensive Review
by Dushyant Singh Dahiya, Hamzah Akram, Aman Goyal, Abdul Moiz Khan, Syeda Shahnoor, Khawaja M. Hassan, Manesh Kumar Gangwani, Hassam Ali, Bhanu Siva Mohan Pinnam, Saqr Alsakarneh, Andrew Canakis, Abu Baker Sheikh, Saurabh Chandan and Amir Humza Sohail
J. Clin. Med. 2024, 13(11), 3034; https://doi.org/10.3390/jcm13113034 - 22 May 2024
Viewed by 382
Abstract
Globally, acute appendicitis has an estimated lifetime risk of 7–8%. However, there are numerous controversies surrounding the management of acute appendicitis, and the best treatment approach depends on patient characteristics. Non-operative management (NOM), which involves the utilization of antibiotics and aggressive intravenous hydration, [...] Read more.
Globally, acute appendicitis has an estimated lifetime risk of 7–8%. However, there are numerous controversies surrounding the management of acute appendicitis, and the best treatment approach depends on patient characteristics. Non-operative management (NOM), which involves the utilization of antibiotics and aggressive intravenous hydration, and surgical appendectomy are valid treatment options for healthy adults. NOM is also ideal for poor surgical candidates. Another important consideration is the timing of surgery, i.e., the role of interval appendectomy (IA) and the possibility of delaying surgery for a few hours on index admission. IA refers to surgical removal of the appendix 8–12 weeks after the initial diagnosis of appendicitis. It is ideal in patients with a contained appendiceal perforation on initial presentation, wherein an initial nonoperative approach is preferred. Furthermore, IA can help distinguish malignant and non-malignant causes of acute appendicitis, while reducing the risk of recurrence. On the contrary, a decision to delay appendectomy for a few hours on index admission should be made based on the patients’ baseline health status and severity of appendicitis. Post-operatively, surgical drain placement may help reduce postoperative complications; however, it carries an increased risk of drain occlusion, fistula formation, and paralytic ileus. Furthermore, one of the most critical aspects of appendectomy is the closure of the appendiceal stump, which can be achieved with the help of endoclips, sutures, staples, and endoloops. In this review, we discuss different aspects of management of acute appendicitis, current controversies in management, and the potential role of endoscopic appendectomy as a future treatment option. Full article
(This article belongs to the Special Issue Update on the Diagnosis and Treatment of Appendicitis)

Other

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12 pages, 1536 KiB  
Systematic Review
Utility of Ischemia-Modified Albumin as a Biomarker for Acute Appendicitis: A Systematic Review and Meta-Analysis
by Apoorv Singh, Zenon Pogorelić, Aniket Agrawal, Carlos Martin Llorente Muñoz, Deepika Kainth, Ajay Verma, Bibekanand Jindal, Sandeep Agarwala and Sachit Anand
J. Clin. Med. 2023, 12(17), 5486; https://doi.org/10.3390/jcm12175486 - 24 Aug 2023
Cited by 6 | Viewed by 1744
Abstract
Background: Acute appendicitis is a frequently encountered surgical emergency. Despite several scoring systems, the possibility of delayed diagnosis persists. In addition, a delayed diagnosis leads to an increased risk of complicated appendicitis. Hence, there is a need to identify biological markers to help [...] Read more.
Background: Acute appendicitis is a frequently encountered surgical emergency. Despite several scoring systems, the possibility of delayed diagnosis persists. In addition, a delayed diagnosis leads to an increased risk of complicated appendicitis. Hence, there is a need to identify biological markers to help clinicians rapidly and accurately diagnose and prognosticate acute appendicitis with a high sensitivity and specificity. Although several markers have been evaluated, the pressing concern is still the low specificity of these markers. One such marker is serum ischemia-modified albumin (IMA), which can be a novel biomarker for accurately diagnosing and prognosticating acute appendicitis. Methods: The authors conducted a systematic search of the PubMed, EMBASE, Web of Science, and Scopus databases through February 2023 as per the PRISMA guidelines. The difference in the levels of IMA between patients with acute appendicitis vs. healthy controls, and the difference in the levels of IMA between patients with complicated vs. non-complicated acute appendicitis were taken as the outcome measures. Statistical analysis was performed using a random effects model and mean difference (MD) was calculated. The methodological quality of the studies was assessed by utilizing the Newcastle–Ottawa scale. Results: A total of six prospective comparative studies were included in the meta-analysis. The analysis revealed that the mean level of serum IMA was significantly raised in the acute appendicitis group (MD 0.21, 95% CI 0.05 to 0.37, p = 0.01). Similarly, the mean serum IMA levels were also raised in the complicated appendicitis group compared to the non-complicated appendicitis group (MD 0.05, 95% CI 0.01 to 0.10, p = 0.02). Three of the studies included were, however, of poor methodological quality. Conclusions: Serum IMA is a viable potential marker for diagnosing and prognosticating acute appendicitis. However, due to the limited methodological quality of available studies, further prospectively designed and adequately powered studies are needed. Full article
(This article belongs to the Special Issue Update on the Diagnosis and Treatment of Appendicitis)
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14 pages, 568 KiB  
Systematic Review
The Impact of Obesity on Perioperative Outcomes for Children Undergoing Appendectomy for Acute Appendicitis: A Systematic Review
by Nikolaos Zavras, Natalia Vaou, Sofia Zouganeli, Arezina Kasti, Papakonstantinou Dimitrios and George Vaos
J. Clin. Med. 2023, 12(14), 4811; https://doi.org/10.3390/jcm12144811 - 21 Jul 2023
Viewed by 1065
Abstract
Today, the prevalence of obesity in the pediatric population has increased dramatically. Acute appendicitis (AA) is the most common surgical condition among pediatric patients. We aimed to investigate the impact of obesity on postoperative outcomes in terms of operative time (OT), length of [...] Read more.
Today, the prevalence of obesity in the pediatric population has increased dramatically. Acute appendicitis (AA) is the most common surgical condition among pediatric patients. We aimed to investigate the impact of obesity on postoperative outcomes in terms of operative time (OT), length of stay (LOS), surgical site infection (SSI), overall complications, adverse events, and mortality in children undergoing appendectomy for acute appendicitis. An extensive search of the literature in PubMed and Google Scholar was conducted to evaluate the outcomes of normal weight (NW), overweight (OW), and obese (OB) children who underwent appendectomy. Although no statistically significant differences were noted in perioperative outcomes and overall postoperative complications between OW/OB and NW children in the majority of the included studies, prolonged OT and LOS and SSI were found in some studies. Moreover, no differences in terms of readmissions and ED visits were recorded. We conclude that the impact of obesity on postoperative outcomes for children undergoing appendectomy for AA is unclear, and, therefore, no safe conclusions can be drawn with the currently available data. Due to the lack of high-quality studies, further research is required to optimize the surgical approach and prevent unwarranted complications. Full article
(This article belongs to the Special Issue Update on the Diagnosis and Treatment of Appendicitis)
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