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Treatment of acute appendicitis in geriatric patients – literature review

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Kot A., Kenig J., Wałęga P.
Polish Journal of Surgery
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2016
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vol. 88(3)
136-141
EN
Demographic changes associated with the aging population mean that surgeons increasingly have contact and make decisions about treating patients from the oldest age groups. The aim of the study was to review the literature concerning the treatment of acute appendicitis in patients over the age of 60 years old. Material and methods. A review of the literature published in the years 2000-2015 has been carried out using the PubMed database. The initial number of results corresponding to the query in English, „appendicitis (MeSH) AND elderly (MeSH)” was 260. Selection based on the titles, abstracts, and eventually whole articles, ultimately resulted in 11 papers concerning the treatment of appendicitis in patients above 60 years of age. Results. Nine papers were retrospective and 2 were prospective. In total, the studies included 82,852 patients. Laparoscopic appendectomy was associated with a lower mortality rate, a smaller number of postoperative complications and a shorter length of hospital stay, which led to it being recommended by most authors. Four of the ten papers demonstrated that the patients who were qualified for laparoscopic surgery had less comorbidity and were in a lower ASA (American Society of Anaesthesiology) category. Antibiotic therapy as an independent method was assessed in one study in a group of elderly people, on a selected group of 26 patients, and its effectiveness was shown to be 70%. Most studies, however, are highly heterogeneous which significantly hindered comparisons. Conclusions. Currently, laparoscopic appendectomy seems to be the treatment of choice in the elderly with acute appendicitis. Antibiotic therapy, as an independent method of treatment of acute appendicitis, cannot currently be recommended. However, further, prospective, and better-designed studies are needed, involving a larger number of patients, and primarily dedicated to the elderly.
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An Analysis of Factors Influencing Accuracy of the Diagnosis of Acute Appendicitis

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Żyluk A., Ostrowski P.
Polish Journal of Surgery
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2011
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vol. 83
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issue 3
135-143
EN
The aim of the study was to "refresh" the knowledge about the course of acute appendicitis, to confront the classical clinical picture with the practice, analyze its fluctuations and identify factors influencing these.Material and methods. All patients admitted to the Department of General Surgery in Grudziądz District Hospital with the suspicion of acute appendicitis, who underwent appendectomy and in whom the appendicitis was confirmed in pathologic examination were included in the study. There were 85 patients, 49 men (58%) and 36 women (42%) in a mean age of 30 years (range 10-75). Symptoms, signs and results of biochemical tests (leukocyte rate and CRP) were considered in the analysis.Results. The commonest constellation of symptoms and signs, occurring in at least of 3/4 patients consisted of pain and tenderness localized in right lower quadrant (100%), which exacerbates at movements (98%), felling unwell (93%), loss of appetite (88%), and rebound tenderness in right lower quadrant (74%).Conclusions. No particular fluctuation of clinical features in relation to gender, age, duration of symptoms, biochemical parameters and morphological severity of the inflammation was observed. Relevant findings included relatively fast development (<12 hrs) of advanced appendicitis in 18% of adult patients and more than a half patients with normal body temperature, regardless true appendicitis.
3
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Does abdominal ultrasound is a useful tool in appendicitis diagnosis?

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Kamiński M.
Polish Journal of Surgery
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2018
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vol. 90(3)
13-18
EN
Introduction: Acute appendicitis is the most common acute abdominal illness. Despite progress in diagnosis, there is still a 20% negative appendectomy rate. The aim of the study was to determine the usefulness of abdominal sonography in the diagnosis of acute appendicitis. Materials and methods: Data were collected retrospectively from 326 patients operated with suspected appendicitis, who had undergone abdominal ultrasound prior to surgery. Appendicitis was confirmed by pathology reports. There were two variants of positive abdominal sonography. In the first, positive ultrasound was visualized inflamed appendix. In the second variant, the sonographic diagnosis of appendicitis was based on a visualized inflamed appendix or one of indirect signs of appendicitis – localized periappendiceal fluid collection, enlarged lymph nodes, thickening of the intestinal wall in the right iliac fossa. Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were defined and compared. Results: 83.74% patients have appendicitis in their pathologic report. In 39.53% cases, the appendix was visualized via abdominal ultrasound. In 65.95% cases of sonography, there occurred indirect signs. In the first variant, sensitivity, specificity, PPV and NPV amounted to 47.99%, 79.25%, 92.25% and 22.83%, respectively. In the second variant, they amounted to 67.77%, 43.40%, 86.05% and 20.72%, respectively. In the second variant, sensitivity was significantly higher (p<0.001), however specificity was significantly lower (p<0.001). Conclusion: Limited sensitivity and specificity cannot be a confirmation of appendicitis. The typical clinical course with a negative ultrasound should not delay correct diagnosis and early surgical treatment.
4
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Factors affecting the effectiveness of conservative management of appendicular mass

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Almoamin H. H. A.
Polish Journal of Surgery
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2021
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vol. 93
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issue 3
17-21
EN
Introduction: Acute appendicitis is the most common surgical emergency in children. Appendicular mass is a relatively common complication in improperly treated patients. The management of appendicular mass remains controversial. Aim: This study aims at determining factors affecting the effectiveness of conservative management of appendicular mass. Material and methods: This was a retrospective study of 71 children younger than 15 years with appendicular mass managed at Basra Children’s Specialty Hospital during the period between 2015 and 2019. Factors like age of the patient, duration of symptoms prior to hospital admission, size of the mass, complications, hospital stay and outcome are reviewed. Results: Appendicular mass complicates 3.9% of all cases of acute appendicitis. Conservative management of appendicular mass was effective in 84.5%. Appendicular mass occurred most frequently in children aged 5–10 years (48%). Male is more frequently affected than female with a ratio of 1.4. Regarding age effect on the efficacy of conservative management of appendicular mass, there is a significant association with P-value = 0.017. Duration of symptoms or size of the mass has no significant association with the success of conservative management. No mortality or major surgical complications are encountered. Although effective, conservative management prolongs the length of hospital stay. Conclusion: Conservative management of appendicular mass in children should be revised particularly in children younger than 5 years old, wherein operative treatment may be the first option. The reasons for that are high rate of failure of conservative management with early progress to appendicular abscess. These could be explained by the underdevelopment of the greater omentum lacking its protective effect in limiting the spread of inflammation. In addition, early appendectomy has the following advantages: decreased risk of adhesive intestinal obstruction, shortening of hospital stay (i.e, less economic burden), and avoidance of second readmission for interval appendectomy
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Risk of complications and 30-day mortality after laparoscopic and open appendectomy in a Danish region, 1998-2007; a population-based study of 18,426 patients

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Bregendahl S., Nørgaard M., Laurberg S., Jepsen P.
Polish Journal of Surgery
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2013
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vol. 85
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issue 7
395-400
EN
Acute appendicitis is the most common abdominal surgical emergency, but population-based data on the risk of complications after laparoscopic appendectomy (LA) and open appendectomy (OA) are scarce. The aim of the study was to describe the risk of complications and mortality after appendectomy for acute appendicitis during a 10-year period, and to compare outcomes after LA and OA. Material and methods. Using population-based registry data, we conducted a historical cohort study in a Danish region (population 2,000,000) including all patients who underwent appendectomy for acute appendicitis during the period of 1998-2007. We used logistic regression to compare the risk of complications and 30-day mortality between LA and OA, adjusting for gender, age, severity of appendicitis, time of surgery, and calendar year. Analyses were stratified for severity of appendicitis and time period. Results. We included 18,426 patients. From 1998 to 2007 the use of LA rose from 12% to 61%, while the risk of surgically-treated complications fell from 5.7% to 3.2%, the risk of intra-abdominal infections fell from 2.4% to 1.1% and 30-day mortality fell from 0.30% to 0.23%. LA was associated with a lower risk of surgically-treated complications (adjusted odds ratio for LA vs. OA=0.70 (95% CI, 0.57-0.85), intraabdominal infections (OR=0.74 [95% CI, 0.55-0.99]) and mortality (OR=0.48 [95% CI, 0.18-1.30]). LA was safer than OA for simple and complicated appendicitis throughout the study period. Conclusions. Risk of complications and 30-day mortality decreased in Denmark between 1998 and 2007 concurrently with implementation of LA. The risk of complications was lower after LA than after OA
6
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Intussuception at Atypical Ages in Children and Adults - 11 Years Experiences

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Peyvasteh M., Askarpour S., Javaherizadeh H., Beigom Al-Taha B.
Polish Journal of Surgery
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2011
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vol. 83
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issue 6
304-309
EN
Intussusception is a curious anatomic condition characterized by the invagination of one segment of the gastrointestinal tract into the lumen of an adjacent segment. Once initiated, additional intestinal telescopes into the distal segment, causing the invaginated intestine to propagate distally within the bowel lumen.The aim of the study was to evaluate the clinical manifestation, etiology, and outcome of intussuception at atypical ages.Material and methods. This retrospective study was carried out on patients aged <6 mo or >2 yr with intussusception. Duration of study was from March, 20, 1997 to March, 20, 2008. The places of study were Imam Khomeini and Abuzar referrals hospital. Cases were classified according to age and sex. According to age, patients were <6 mo, 2-10 years, 10-18, and more than 18 years. Age, sex, history, chief complaint, clinical manifestation, sonographic findings, duration of clinical manifestation, method of treatment, outcome, duration of hospital staying, and ICU admission were studied. Data were analyzed with SPSS ver 16 (Chicago, IL, USA) and Epi-info.Results. In this study, 36 cases with diagnosis of intussusception at atypical ages, <6 mo or >2 yr, were included. From all cases, 21 cases (58.3%) were 2 through 10 years and male: female ratio was 2.26:1. Ten cases (27.8%) had history of medical condition. Eighty percent (29 cases) had abdominal pain and 20 cases (58.3%) had vomiting. Abdominal mass was found in 14 cases (38.8%). Sonography was done for 30 (83.3%) of cases and suggesting intussuception in 25 (69.4%) of cases. Intussuception was reduced by hand and performed appendectomy for 10 cases (27.8%). Bowel resection was done for 19 cases (52.8%) and radiological reduction was done for 2 cases (5.6%). Eighteen (50%) cases had anemia. Twenty-five cases admitted to ICU. One (2.8%) patient died (a 65 year old woman). Appendicitis is the most common well defined injury associated with intussusception.Conclusion. This study showed that with advancing age, incidence of intussusception will be decreased. As age increasing, rate of bowel resection will be increased. All cases with appendectomy and reduction by hand had hospital staying 3-10 days. The results of this study was similar to other studies. The most widely used diagnostic procedure for intussusception was sonography.
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