Search Results (104)

Introduction: Acute appendicitis (AA) is a common cause of abdominal pain that can lead to complications like perforation and intra-abdominal abscesses, increasing morbidity and mortality, often requiring emergency surgery. Nevertheless, appendectomy is performed in up to 95% of uncomplicated cases, while complications like perforation and intra-abdominal abscesses increase morbidity and mortality. The current study compares the accuracy of GPT-4.5, DeepSeek R1, and machine learning in assisting with surgical decision-making for patients presenting with lower abdominal pain at the Emergency Department. Methods: In this multicenter retrospective study, 63 histopathologically confirmed appendicitis patients and 50 control patients with right abdominal pain presenting at the Emergency Department at two German hospitals between October 2022 and October 2023 were included. Using each patient’s clinical, laboratory, and radiological findings, DeepSeek (with and without Retrieval-Augmented Generation using 2020 Jerusalem guidelines) was compared in terms of accuracy with GPT-4.5 and a random forest-based machine-learning model, with a board-certified surgeon (reference standard) to determine the optimal treatment approach (laparoscopic exploration/appendectomy versus conservative antibiotic therapy). Results: Accuracy of agreement with board-certified surgeons in the decision-making of appendectomy versus conservative therapy increased non-significantly from 80.5% to 83.2% with DeepSeek and from 70.8 to 76.1% when GPT-4.5 was provided with the World Journal of Emergency Surgery 2020 Jerusalem guidelines on the diagnosis and treatment of acute appendicitis. The estimated machine-learning model training accuracy was 84.3%, while the validation accuracy for the model was 85.0%. Discussion: GPT-4.5 and DeepSeek R1, as well as the machine-learning model, demonstrate promise in aiding surgical decision-making for appendicitis, particularly in resource-constrained settings. Ongoing training and validation are required to optimize the performance of such models. Full article

Background: While the severity of acute appendicitis is routinely evaluated, the significance of its morphological characteristics remains underexplored. This study aimed to evaluate the clinical impacts of appendiceal dimensions. Methods: This retrospective study included patients who underwent appendectomy. Data on demographics, appendiceal morphology, time from admission to surgery, postoperative complications, and readmission rates were analyzed. Statistical tests, including correlation analysis and multivariate regression, were used. p-value ≤ 0.05 was considered statistically significant. Results: Appendix diameter demonstrated positive correlations with age, complicated appendicitis, and surgery duration. Multivariate analysis showed that appendix diameter was found to be a significant predictor of readmission rates, regardless of clinical factors, and has a significant positive association with age in both univariate/multivariate analyses. Conclusions: Our findings demonstrate the significance of appendicular morphology in the prediction of readmission rates and the importance of age-specific diagnostic thresholds. The observed age-related changes may warrant re-evaluation of recent diagnostic criteria. Full article

Background and Objectives: Accurately diagnosing acute appendicitis (AA) in children remains clinically challenging due to overlapping symptoms with other pediatric conditions and limitations in conventional diagnostic tools. The systemic immune-inflammation index (SII) has emerged as a promising biomarker in adult populations; however, its utility in pediatrics is still unclear. This study aimed to evaluate the diagnostic accuracy of SII in distinguishing pediatric acute appendicitis from elective non-inflammatory surgical procedures and to assess its predictive value in identifying complicated cases. Materials and Methods: This retrospective, single-center study included 397 pediatric patients (5–15 years), comprising 297 histopathologically confirmed appendicitis cases and 100 controls. Demographic and laboratory data were recorded at admission. Inflammatory indices including SII, neutrophil-to-lymphocyte ratio (NLR), and platelet-to-lymphocyte ratio (PLR) were calculated. ROC curve analysis was performed to evaluate diagnostic performance. Results: SII values were significantly higher in the appendicitis group (median: 2218.4 vs. 356.3; p < 0.001). SII demonstrated excellent diagnostic accuracy for AA (AUROC = 0.95, 95% CI: 0.92–0.97), with 91% sensitivity and 88% specificity at a cut-off > 624. In predicting complicated appendicitis, SII showed moderate discriminative ability (AUROC = 0.66, 95% CI: 0.60–0.73), with 83% sensitivity but limited specificity (43%). Conclusions: SII is a reliable and easily obtainable biomarker for diagnosing pediatric acute appendicitis and may aid in early detection of complicated cases. Its integration into clinical workflows may enhance diagnostic precision, particularly in resource-limited settings. Age-specific validation studies are warranted to confirm its broader applicability. Full article

Background and Objectives: Acute appendicitis is a common surgical emergency, and while appendectomy typically results in good outcomes, post-operative complications, like intra-abdominal abscesses, can occur. Traditional biomarkers, such as white blood cells count and C-reactive protein, often lack the accuracy needed for early detection. Procalcitonin is emerging as a potential marker for predicting post-operative infections. This pilot study evaluates the role of kinetics of procalcitonin, measured via point-of-care testing, in predicting abscess formation in patients with non-complicated appendicitis. Materials and Methods: The study involved 33 patients undergoing appendectomy for non-complicated acute appendicitis. The levels of procalcitonin were measured at four time points: pre-operatively (T0), post-operatively (T1), on the first post-operative day (T2), and at discharge (T3). The primary outcome was the development of post-operative abscesses, confirmed by imaging or intervention. Results: Four patients (12%) developed abscesses. The levels of procalcitonin were significantly higher in the abscess group at all time points compared to the non-abscess group (p < 0.05). The levels of procalcitonin in the abscess group plateaued after an initial post-operative decline, while levels steadily decreased in the non-abscess group. Conclusions: Procalcitonin, particularly its kinetic profile, may serve as a valuable early marker for predicting post-operative abscess formation. Point-of-care testing for procalcitonin can enable timely intervention, improving outcomes. Kinetics of procalcitonin show promise as a predictor for post-operative abscesses after appendectomy, though larger studies are needed to confirm these findings. Full article

Background: Acute appendicitis is a common emergency requiring abdominal surgery. Despite its prevalence, there are no specific biomarkers for its diagnosis and prognosis. The aim of this study was to assess the basic laboratory tests of patients with acute appendicitis and to evaluate and integrate biochemical variables into the diagnosis of appendicitis. Methods: This was a retrospective, cross-sectional cohort study that included data from patients who underwent an appendectomy. Two groups of patients were considered based on their surgical (non-complicated/complicated appendicitis) or pathological diagnosis (non-perforated/perforated appendicitis). Factor analysis was carried out to identify communalities to put forward classificatory indices. Receiver operating characteristic (ROC) analysis was used to assess the accuracy of the predictions. Results: The cohort included 246 patients (51.6% male, mean age: 24.79 ± 19.32 years). By using their biochemical data, we generated 6 new indices whose areas under the ROC curve (AUC) ranged between 0.632 and 0.762 for complicated appendicitis and from 0.597 to 0.742 for perforated appendicitis. Inflammatory Metabolic Index (IMI) at the fixed cutoffs was a promising biomarker for both histopathological and surgical diagnoses with odds ratios (OR) of 10.45 and 5.21, respectively. The Metabolic-Inflammatory Stress Index (MISI) showed high specificity (over 72%) and significant AUC values for both diagnoses (0.742 and 0.676). These findings were reinforced by significant p-values and Youden indices. Conclusions: IMI and MISI were demonstrated to be effective biomarkers for complicated and perforated appendicitis. IMI provides predictive capability, while MISI offers specificity and significant AUC values for both histopathological and surgical diagnoses. Incorporating these biomarkers could enhance the accuracy of appendicitis diagnosis and potentially guide clinical decision-making. Full article

Background: This systematic review aimed to comprehensively evaluate the clinical, diagnostic, and therapeutic features of synchronous acute cholecystitis (AC) and acute appendicitis (AAP). Methods: The review protocol was prospectively registered in PROSPERO (CRD420251086131) and conducted in accordance with PRISMA 2020 guidelines. A systematic search was performed across PubMed, MEDLINE, Web of Science, Scopus, Google Scholar, and Google databases for studies published from January 1975 to May 2025. Search terms included variations of “synchronous,” “simultaneous,” “concurrent,” and “coexistence” combined with “appendicitis,” “appendectomy,” “cholecystitis,” and “cholecystectomy.” Reference lists of included studies were screened. Studies reporting human cases with sufficient patient-level clinical data were included. Data extraction and quality assessment were performed independently by pairs of reviewers, with discrepancies resolved through consensus. No meta-analysis was conducted due to the descriptive nature of the data. Results: A total of 44 articles were included in this review. Of these, thirty-four were available in full text, one was accessible only as an abstract, and one was a literature review, while eight articles were inaccessible. Clinical data from forty patients, including two from our own cases, were evaluated, with a median age of 41 years. The gender distribution was equal, with a median age of 50 years among male patients and 36 years among female patients. Leukocytosis was observed in 25 of 33 patients with available laboratory data. Among 37 patients with documented diagnostic methods, ultrasonography and computed tomography were the most frequently utilized modalities, followed by physical examination. Twenty-seven patients underwent laparoscopic cholecystectomy and appendectomy. The remaining patients were managed with open surgery or conservative treatment. Postoperative complications occurred in five patients, including sepsis, perforation, leakage, diarrhea, and wound infections. Histopathological analysis revealed AAP in 25 cases and AC in 14. Additional findings included gangrenous inflammation and neoplastic lesions. Conclusions: Synchronous AC and AAP are rare and diagnostically challenging conditions. Early recognition via imaging and clinical evaluation is critical. Laparoscopic management remains the preferred approach. Histopathological examination of surgical specimens is essential for identifying unexpected pathology, thereby guiding appropriate patient management. Full article

Background/Objectives: War conflicts impact public health and patient hospital presentations. We aimed to assess the incidence and severity of acute appendicitis (AA) in children during the 2023 Israeli–Hamas–Hezbollah war. Methods: This multicenter retrospective cohort study included children (<18 years) admitted with AA in six medical centers in a 2-month period during the war (7 October–30 November 2023) and a comparable period in 2022. Demographic, clinical, laboratory, imaging, treatment, and outcome data were collected at individual medical centers and analyzed, with subgroup analysis based on proximity to conflict zones. Statistical tests used were Kolmogorov–Smirnov test, Student’s t-test, Mann–Whitney U, and Pearson chi square. p < 0.05 was considered significant. Results: Among 209 patients (106 in 2023, 103 in 2022), a higher rate of complicated AA during wartime was observed, although not statistically significant (27% vs. 18%, p = 0.11). The median symptom-to-presentation time remained 24 h (p = 0.64). The overall incidence of AA decreased by 20% in medical centers near conflict zones but increased by 28% in centers distant from conflict zones. The proportion of complicated AA doubled during the war in hospitals close to conflict zones as compared to during pre-war time (16% vs. 9%, respectively, p = 0.016), with a trend toward higher C-reactive protein (CRP) levels [26.5 (5.3–107.0) vs. 13 (3.4–40.9), respectively, p = 0.075], although symptom-to-presentation times remained unchanged (24 h in both groups, p = 0.32). Conclusions: Proximity to war zones was associated with an increase in the rate of complicated appendicitis in children. While the causes remain unclear, this finding highlights the complex impact of war on healthcare in general and on the well-being of children in particular. Full article

Background: Pediatric acute appendicitis (AAP) is a common cause of abdominal pain in children, yet accurate classification into negative, uncomplicated, and complicated forms remains clinically challenging. Misclassification may lead to unnecessary surgeries or delayed treatment. This study aims to evaluate and compare the diagnostic accuracy of five machine learning models (AdaBoost, XGBoost, Stochastic Gradient Boosting, Bagged CART, and Random Forest) for classifying pediatric AAP subtypes. Methods: In this retrospective observational study, a dataset of 590 pediatric patients was analyzed. Demographic information and laboratory parameters—including C-reactive protein (CRP), white blood cell (WBC) count, neutrophils, lymphocytes, and appendiceal diameter—were included as features. The cohort consisted of negative (19.8%), uncomplicated (49.2%), and complicated (31.0%) AAP cases. Five ensemble machine learning models (AdaBoost, XGBoost, Stochastic Gradient Boosting, Bagged CART, and Random Forest) were trained on 80% of the dataset and tested on the remaining 20%. Model performance was evaluated using accuracy, sensitivity, specificity, and F1 score, with cross-validation employed to ensure result stability. Results: Random Forest demonstrated the highest overall accuracy (90.7%), sensitivity (100.0%), and specificity (61.5%) for distinguishing negative and uncomplicated AAP cases. Meanwhile, XGBoost outperformed other models in identifying complicated AAP cases, achieving an accuracy of 97.3%, sensitivity of 100.0%, and specificity of 78.3%. The most influential biomarkers were neutrophil count, appendiceal diameter, and WBC levels, highlighting their predictive value in AAP classification. Conclusions: ML models, particularly Random Forest and XGBoost, exhibit strong potential in aiding pediatric AAP diagnosis. Their ability to accurately classify AAP subtypes suggests that ML-based decision support tools can complement clinical judgment, improving diagnostic precision and patient outcomes. Future research should focus on multi-center validation, integrating imaging data, and enhancing model interpretability for broader clinical adoption. Full article

Background: The simultaneous surgical treatment of acute appendicitis and inguinal hernia in children is still controversial. However, there are no established guidelines for the simultaneous surgical treatment of pediatric patients with acute appendicitis and inguinal hernia. The aim of this study is to evaluate the safety and efficacy of a simultaneous laparoscopic approach for acute appendicitis and inguinal hernia in a pediatric population. Methods: The case records of 2254 pediatric patients who underwent appendectomy at our institution between 1 January 2012 and 1 January 2025 were reviewed. Finally, 44 patients who met the inclusion criteria and had an inguinal hernia at the time of laparoscopic appendectomy were selected for further analysis. The patients who underwent single-stage surgery (simultaneous laparoscopic appendectomy and hernia repair) were assigned to group I (n = 25), while the patients who underwent delayed laparoscopic hernia repair were assigned to group II (n = 19). The groups were compared for final outcome, complications, rate of readmissions within 30 days of index surgery, duration of surgery, and length of hospital stay. Results: The mean age of all the included patients was 11.5 ± 4.0 years, with males slightly outnumbering females (n = 25, 56.8%). The study population consisted of two comparable groups in terms of age, anthropometric measures, gender distribution, and baseline clinical characteristics. A major difference between the two methods was the operation time, which was significantly longer in the single-stage group (53.5 ± 11.2 min vs. 41.5 ± 10.9 min; p = 0.001). Despite the difference in operative time, the length of hospital stay (3.5 ± 2.0 days vs. 3.5 ± 2.2 days; p = 0.899) was almost identical between the two groups, suggesting that the additional intraoperative time was not reflected in a prolonged recovery time. In addition, postoperative complications were rare and evenly distributed between both surgical strategies (n = 2 (8%) vs. n = 2 (10.5%); p = 0.772). All the complications were minor and were treated conservatively. Importantly, there was no recurrence of hernia in either group during the follow-up period. Conclusions: From a clinical perspective, these results suggest that the single-stage approach is feasible and safe, even in complicated appendicitis, particularly in cases where the postponement of hernia repair is not desirable. The longer operative time associated with the single-stage approach must be weighed against the potential benefits of avoiding a second surgical procedure and unnecessary anesthesia, reducing overall healthcare utilization, and minimizing patient burden. Full article

Background and objectives: Pelvic inflammatory disease (PID), primarily associated with sexually transmitted infections (STIs), represents a diagnostic challenge in virgin pediatric patients due to the often vague, non-specific symptomatology, which can mimic other conditions. Management prioritizes targeted antimicrobial therapy, with surgical intervention reserved for complications like tubo-ovarian abscess (TOA). The present systematic review aimed to critically evaluate the available evidence from case reports of PID in virgin pediatric and adolescent patients. Methods: The search strategy was in accordance with PRISMA guidelines. Case reports published up to March 2025 were searched through PubMed, Embase, Scopus, and Google Scholar databases. We included English-language case reports on non-sexually active pediatric and adolescent patients with available full text, excluding commentaries, reviews, and editorials. The Critical Appraisal Checklist for Case Reports was used for the quality assessment of case reports. Through descriptive analysis, PID symptoms, diagnostic, and management modalities were reviewed. The quality of the included case reports was assessed using the JBI Critical Appraisal Checklist. This review was not registered and did not receive external funding. Results: Among the 56 case reports searched, 20 reports were selected and analyzed based on eight criteria. The most frequently reported symptoms were lower abdominal pain (95.8%), fever (63.6%), and gastrointestinal symptoms (50%). Common comorbidities included urinary tract infections (22.7%), congenital anomalies (18.1%), and appendicitis history (18.1%). Escherichia coli and Streptococcus species were the predominant pathogens identified. All patients received antibiotic therapy, while 90.9% underwent surgical intervention. Favorable outcomes were achieved in 72.7% of cases, though 27.2% experienced complications or recurrences. Conclusions: Although commonly linked to sexual activity, PID should be considered in sexually inactive pediatric patients presenting with abdominal pain and adnexal masses. Early diagnosis, appropriate imaging, and timely treatment are crucial to improve outcomes and reduce complications. The evidence in this review is limited by its reliance on case reports, which may introduce bias and restrict generalizability. Full article

Background: Hyponatremia has been identified as a marker of disease severity in various inflammatory conditions. However, its role in predicting acute complicated appendicitis (ACA) in children remains under investigation. This study evaluated the association between preoperative hyponatremia and ACA in a pediatric population. Methods: A retrospective study was conducted on pediatric patients treated for acute appendicitis in two major pediatric centers in Greece. Patients were categorized into groups based on the presence of acute uncomplicated appendicitis (AUA) and acute complicated appendicitis (ACA). Preoperative laboratory parameters were analyzed to identify potential predictors of ACA. Results: This study included 491 pediatric patients, with a mean age of 10 years. ACA patients exhibited significantly lower Na levels compared to those with AUA (136 vs. 138 mmol/L, p < 0.001). Hyponatremia (<135 mmol/L) was present in 38.4% of ACA cases compared to 2.2% of AUA cases (p < 0.001), and was associated with a significantly increased risk of ACA (OR = 18.30, p < 0.001). A sodium threshold of 135 mmol/L also demonstrated a sensitivity of 48% and a specificity of 92.1% Conclusions: Hyponatremia is a strong and specific predictor of ACA in children. When combined with other inflammatory markers, it may enhance early risk stratification, aiding in timely surgical decision making. Full article

Background/Objectives: Endometriosis can present as ovarian endometriosis in 15–25% of the cases. While chronic pelvic pain and dysmenorrhea dominate its clinical presentation, acute complications, such as spontaneous OMA rupture, are rare (<3%), often mimicking acute abdominal pain and necessitating emergency surgery. Diagnostic delays persist due to the condition’s rarity and overlapping symptoms with ovarian torsion or appendicitis. This study investigates the clinical features of ruptured OMAs to enhance preoperative suspicion and optimize management. Methods: From February 2011 to August 2023, 14 patients with spontaneous rupture of histologically confirmed endometriomas underwent emergency laparoscopy for acute abdominal pain in the University Hospital of Bern, Switzerland. The clinical data of these patients were analyzed to find common patterns of spontaneous endometrioma ruptures. We also conducted a literature search in PubMed, Scopus, ScienceDirect, Cochrane, and Embase databases from inception to December 2023 in order to identify other possible confounding factors. The search was based on the keywords “ruptured endometrioma”. All English full-text prospective and retrospective observational and interventional studies with at least five patients that described the clinical features and findings of women diagnosed with ruptured endometrioma and treated surgically were included. Results: The median age at operation was 37.4 (23–49) years old, and all cases presented with acute abdominal pain, with/without peritonitis. Only 3/14 patients presented with fever, while the most common laboratory finding was an elevated CRP level of 45.6 mg/L (3–100 mg/L), while leukocytosis was less pronounced, with a median of 12.2 G/L (6.04–21.4 G/L). Notably, 64.3% (9 out of 14) of the patients reported experiencing dysmenorrhea, while for the remaining 5 individuals, the presence or absence of dysmenorrhea could not be obtained. Interestingly, only one patient had undergone hormonal treatment, with a combined oral contraceptive (COC) of Ethinylestradiol (0.02 mg) and Desogestrel (0.15 mg), while the other patients either lacked awareness of their endometriosis or expressed reluctance towards hormonal downregulation therapy. The median endometrioma size was 7 cm (3.5–18 cm), and 78.57% of the cases (11 out of 14 patients) had only ovarian endometriosis, while only 3 patients had involvement of compartment A, B, or C according to the # ENZIAN classification. Conclusions: Though rare, spontaneous OMA rupture should be considered in acute abdomen cases, especially with cysts > 5 cm. Hormonal therapy may reduce rupture risk, but more research is needed to confirm this and refine diagnostic strategies. Full article

Introduction: Acute abdominal pain is a prevalent complaint in pediatric emergency departments. Primary care physicians can find it challenging to treat such pain and, in particular, to determine whether it requires emergent surgical intervention. Acute appendicitis is the most common surgical cause of abdominal pain, but it is important to understand that other rare conditions can also be life-threatening. Case presentation: We report the case of a 6-year-old girl who presented to our pediatric emergency center with complaints of acute abdominal pain, vomiting, and diarrhea. She had no notable medical history, including perinatal, surgical, or psychiatric disorders. After finding a bezoar-like structure through a combined enteritis CT scan, reassessing the child’s dietary concerns revealed that the child had experienced symptoms of trichophagia for approximately 3 to 4 years. Enterotomy and the removal of the bezoar were successfully performed. A pediatric psychiatric consultation was carried out to prevent further trichophagia-induced complications. Conclusions: Despite our patient’s relatively young age and the failure to obtain a history of trichophagia at the onset, we successfully diagnosed a rare condition called Rapunzel syndrome. Although several cases of this condition have been reported by pediatric surgeons, we emphasize the role of physicians in pediatric emergency departments when examining children with this rare syndrome. Full article

Background/Objectives: This study examines trends in appendectomy utilization in US emergency departments (EDs) from 2012 to 2021 using National Emergency Department Sample (NEDS) data. The objective is to explore appendectomy frequency, appendicitis management, disease progression, and resource distribution in EDs. A predictive model was developed to forecast trends from 2022 to 2032, aiming to improve patient outcomes and support operational planning in EDs. Methods: A cross-sectional analysis was conducted using NEDS data from 2012 to 2021. Appendectomy trends were assessed in four ways: first, comparing the total number of appendectomies with total ED visits to determine relative frequencies; second, comparing trends in Complicated Appendicitis (CA) and Uncomplicated Appendicitis (UA) patients; third, categorizing each appendicitis type based on clinical complications and comorbidities; and finally, using a linear regression model to predict trends through 2032. Results: During the study period, the overall appendectomy rate decreased, while the proportion of patients with Complicated Appendicitis rose. Appendectomies in patients without complications or comorbidities showed a decline, while those in patients with complications or comorbidities increased. Predictive modeling suggests that trends in all subgroups will continue to rise until 2032. Conclusions: This study highlights evolving appendicitis management trends in EDs. The results advocate for fast-track appendectomy pathways and better resource allocation to enhance efficiency, reduce complications, and improve patient care. These findings assist healthcare systems in preparing for ED throughput challenges and refining surgical management strategies. Full article

Background/Objectives: Appendicitis caused by multi-drug-resistant pathogens is associated with significant postoperative morbidity. However, prospective data on the microbial spectrum and its clinical impact remain limited. Methods: Adults with acute appendicitis undergoing surgery between April 2022 and July 2023 were prospectively enrolled at a single university-affiliated institution. Bacterial cultures from appendiceal and rectal swabs were analyzed, and clinical outcomes were assessed. A telephone follow-up was conducted 30 days postoperatively. Results: A total of 105 patients were included. Multi-drug-resistant pathogens were identified in the appendiceal swabs of twenty-nine patients (27.6%), while six patients (5.7%) harbored multi-drug-resistant organisms (MDROs; according to the criteria of the CDC). Rectal swabs revealed MDROs in 11.4% of cases but showed a limited correlation with appendiceal samples, indicating that rectal colonization does not reliably predict the presence of MDROs in appendicitis. Patients with multi-drug-resistant infections had significantly higher postoperative complication rates (31% vs. 10.5%, p = 0.017), including more Clavien–Dindo grade 3 complications (17.2% vs. 2.6%, p = 0.007) and abdominal abscesses (10.3% vs. 1.3%, p = 0.03). These patients required more frequent postoperative antibiotic treatment (65.5% vs. 40.8%, p = 0.03) and therapy adjustments (37.9% vs. 15.8%, p = 0.02). Hospital stays were also prolonged in the multi-drug-resistant group (a median of 4 days and IQR of 5 days vs. a median of 3 days and IQR of 3 days; p = 0.03). Conclusions: Colonization with multi-drug-resistant pathogens in appendicitis is associated with worse clinical outcomes. The intraoperative microbiological analysis of appendiceal swabs in complicated cases may enable targeted antibiotic therapy, potentially shortening hospital stays, optimizing patient management and reducing healthcare costs. Full article