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Objective Methods and Materials Results Conclusion This study aimed to examine the diseases requiring surgery during pregnancy, the changes in surgical methods over time, and the characteristics of surgeries performed in different trimesters.A retrospective study conducted at Bundang CHA Hospital between 2006 and 2023 analyzed surgeries performed during pregnancy and compared laparoscopic and open approaches across the three trimesters of pregnancy. Additionally, general (appendicitis, cholecystitis) and gynecologic (heterotopic pregnancy, adnexal torsion) cases were compared.Among 36 181 delivery patients, 101 (0.28%) underwent surgery. The most common conditions were appendicitis (44.6%), cholecystitis (1.9%), heterotopic pregnancy (23.8%), adnexal torsion (27.7%), and cancer (1.9%). The laparoscopic group had a shorter operative time (41.5 ± 19.3 vs. 57.9 ± 33.9 min, p = 0.009) and hospital stay (4.9 ± 2.7 vs. 9.0 ± 9.8 days, p = 0.016) than open surgery group. Heterotopic pregnancy (47.1%) and adnexal torsion (39.2%) were common in the first trimester, whereas appendicitis peaked in the second (80%) and third trimesters (66.7%).The increasing use of assisted reproductive technology (ART) has led to a rise in gynecological patients requiring surgery in the first trimester, resulting in more laparoscopic surgeries during this period. Interestingly, an increase in laparoscopic surgery was also observed in general surgery during the second and third trimesters. Perioperative tocolysis was more frequent (51.1% vs. 3.8%, p < 0.001) and of longer duration (4.6 ± 8.8 vs. 0.1 ± 0.6 days, p = 0.001) after general surgical procedures.Laparoscopic surgery during pregnancy offers several advantages such as shorter operative time and hospital stay. Since 2011, laparoscopic surgery for the entire gestational period has been on the rise. [ABSTRACT FROM AUTHOR]

Large B‐cell lymphomas (LBLs) comprise a genetically heterogeneous group of clinically aggressive non‐Hodgkin lymphomas, frequently exhibiting overlapping features with diffuse large B‐cell lymphoma and Burkitt's lymphoma. We report a case of a 24‐year‐old, previously healthy male with a classical clinical presentation of acute appendicitis. The pathologic examination discovered a large B‐cell lymphoma with MYC and BCL6 rearrangements in the excised appendix. The patient was assigned Stage IEA, IPI = 0 and received chemotherapy. This case depicts a very uncommon occurrence of fully localized LBL in a patient of an unusually young age and clinical presentation for this type of lymphoma. [ABSTRACT FROM AUTHOR]

Objective Methods Results Conclusion This systematic review and network meta‐analysis compared various antibiotic treatments with surgical treatment for acute appendicitis.We searched PubMed, Embase, Cochrane Library, and Wanfang databases for randomized controlled trials (RCTs) that met the prespecified inclusion criteria up to July 2023. The interventions included various antibiotics and surgery. The outcomes measured were initial treatment success, treatment success at 1‐year follow‐up, and treatment‐related complications. Meta‐analysis was conducted using R software with the gemtc package. Surfaces under the cumulative ranking curves (SUCRA) were used to rank the interventions.Thirteen RCTs involving nine treatments (cefotaxime [CTX] + tinidazole [TNZ], CTX + metronidazole [MTZ], ampicillin [AMP] + gentamicin [GEN] + MTZ, amoxicillin/clavulanate [AMC] + GEN, meropenem [MEM] + MTZ, AMC, ertapenem [ETP] + MTZ, ETP, and surgery) were included in this network meta‐analysis. In head‐to‐head comparisons, no statistically significant difference was found between any two interventions for initial treatment success (p > 0.05). The SUCRA indicated that surgery ranked first (SUCRA, 66.5%) for initial treatment success. Surgery was associated with an increased treatment success rate at 1‐year follow‐up compared to AMC (OR = 0.01, 95% CrI = 0.00–0.14, p < 0.05), MEM + MTZ (OR = 0.06, 95% CrI = 0.00–0.42, p < 0.05), and AMP + GEN + MTZ (OR = 0.02, 95% CrI = 0.00–0.23, p < 0.05). No statistically significant differences were found between any two interventions regarding complications (p > 0.05).Our network meta‐analysis suggests that surgery ranks highest for initial treatment success and treatment success at 1‐year follow‐up. However, surgery may increase the complication rate. [ABSTRACT FROM AUTHOR]

Background: Surgeons are sometimes reluctant to manage uncomplicated appendicitis non‐operatively. Reasons cited include the risk of recurrent appendicitis and the risk of missed appendiceal malignancy. The aim of this study was to address these uncertainties and determine the long‐term efficacy of antibiotic versus operative management of appendicitis. Method: One‐year follow‐up of patients enrolled in the multicentre, COVID:HAREM cohort study during March‐June 2020 was performed. Initial operative or non‐operative management was determined on a case‐by‐case basis by the responsible surgeon. Outcomes were appendicectomy rate at 1‐year, histology of removed appendix and predictors of unsuccessful antibiotic treatment. Results: A total of 625 patients who had non‐operative management were included. Emergency appendicectomy had been performed by 1‐year in 24% (149/625), with a median time to appendicectomy of 12 days [IQR 1–77] from presentation. Thirty‐one patients had elective appendicectomy. Normal histology was reported in 6% of emergency procedures and 58% of elective ones. There were 7 malignancies and 3 neuroendocrine tumors identified at histology. All patients with malignant histology had ≥1 risk factors for malignancy at initial presentation. Faecolithiasis (hazard ratios (HR) 2.3, 95% confidence intervals (CI) 1.51–3.49) and a high Adult Appendicitis Score (AAS >16; HR 2.44, 95% CI 1.52–3.92) were independent risk factors for unsuccessful non‐operative management. Conclusion: At 1 year, 71% of patients managed non‐operatively did not undergo an appendicectomy. Recurrence of appendicitis was associated with faecolithiasis and a high AAS. Patients at higher risk for appendiceal malignancy should have targeted follow‐up. These factors should be considered when counseling patients on non‐operative management. [ABSTRACT FROM AUTHOR]

Objective: The objective was to investigate the feasibility of prospectively validating multiple clinical prediction scores (CPSs) for pediatric appendicitis in an Australian pediatric emergency department (ED). Methods: A literature search was conducted to identify potential CPSs and a single‐center prospective observational feasibility study was performed between November 2022 and May 2023 to evaluate the performance of identified CPSs. Children 5–15 years presenting with acute right‐sided or generalized abdominal pain and clinician suspicion of appendicitis were included. CPSs were calculated by the study team from prospectively clinician‐collected data and/or review of medical records. Accuracy of CPSs were assessed by area under the receiver operating characteristic curve (AUC) and proportions correctly identifiable as either low‐risk or high‐risk with the best performing CPS compared to clinician gestalt. Final diagnosis of appendicitis was confirmed on histopathology or by telephone/email follow‐up for those discharged directly from ED. Results: Thirty CPSs were identified in the literature search and 481 patients were enrolled in the study. A total of 150 (31.2%) patients underwent appendectomy with three (2.0%) having a normal appendix on histopathology. All identified CPSs were calculable for at least 50% of the patient cohort. The pediatric Appendicitis Risk Calculator for pediatric EDs (pARC‐ED; n = 317) was the best performing CPS with AUC 0.90 (95% confidence interval [CI] 0.86–0.94) and specificity 99.0% (95% CI 96.4%–99.7%) in diagnosing high‐risk cases and a misclassification rate of 4.5% for low‐risk cases. Conclusions: The study identified 30 CPSs that could be validated in a majority of patients to compare their ability to assess risk of pediatric appendicitis. The pARC‐ED had the highest predictive accuracy and can potentially assist in risk stratification of children with suspected appendicitis in pediatric EDs. A multicenter study is now under way to evaluate the potential of these CPSs in a broader range of EDs to aid clinical decision making in more varied settings. [ABSTRACT FROM AUTHOR]

Background: In many centers, pediatric radiology‐performed ultrasound and/or POCUS fellowship training are not readily available. Objective: To present our experience using point of care ultrasound (POCUS) in a pediatric emergency medicine training program without POCUS fellowship‐trained staff, and to demonstrate that POCUS of the appendix is feasible outside the context for POCUS fellowship training. Methods: We identified children diagnosed with appendicitis or periappendiceal abscess from June 2016 to June 2024. Variables reviewed include details of PED visit such as presenting symptoms, laboratory and imaging results, and PED treatment, as well as surgical report and pathology result. We evaluated the frequency and performance characteristics of POCUS over the study period. Results: 999 children were diagnosed with appendicitis. POCUS was performed in 360 of 845 cases (43%) of histology‐confirmed appendicitis and in 19 of 69 cases (28%) in which histology was negative for appendicitis. Both the number of POCUS examinations for appendicitis and the percentage of examinations correctly identifying appendicitis steadily increased over the study period. Accuracy was highest in the 5–10‐year age range and lowest for females from 10 to 15 years. In 96% of cases with a pathology result of appendicitis and a positive POCUS examination, POCUS correctly identified appendicitis. However, only 6 of 19 POCUS examinations in children without appendicitis on histology found no appendicitis. Performance of POCUS for appendicitis was significantly associated with increased opioid administration and a 20‐min mean decrease in length of pediatric emergency department stay. Conclusions: POCUS for appendicitis within the context of PEM fellowship training is feasible and associated with decreased length of stay. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the utility of laboratory ultrasonographic and Doppler ultrasonographic findings in the differentiation of simple and complicated appendicitis. Methods: A prospective study was conducted, including pediatric patients who underwent surgery with the diagnosis of appendicitis. Results: Fifty patients, who were found to have appendicitis on ultrasonographic examination, were included. The mean age was found to be 12.80 ± 3.67 years, with 30% female and 70% male. The patients were histopathologically divided into two groups: simple appendicitis (Group 1, 41 patients, 82%) and complicated appendicitis (Group 2, 9 patients, 18%). CRP (C‐reactive protein) levels (p = 0.004) and periappendiceal fatty tissue thickness (PFI) (p < 0.005) were found to be statistically significantly higher in Group 2 compared to Group 1. The portal vein (PV) diameter and peak systolic velocity (PSV) values were significantly higher in the study group compared to the control group (p = 0.033, p = 0.001). Conclusion: Doppler ultrasonographic examination did not significantly differentiate complicated from simple appendicitis. The CRP value is an independent risk factor in the diagnosis of complicated appendicitis, and the presence of a significant increase in mesenteric tissue thickness is one of the important criteria for differentiating complicated appendicitis from simple appendicitis. [ABSTRACT FROM AUTHOR]

Objective Methods Results Conclusions To compare conservative management and appendectomy for acute appendicitis during pregnancy by trimester.This retrospective cohort study used data from a national inpatient database from July 2010 to March 2022. Pregnant women diagnosed with acute appendicitis were included. Multivariable analysis using generalized estimating equations was performed to compare outcomes between conservative management and appendectomy across trimesters. The main outcomes were preterm labor, preterm delivery, or abortion; antepartum hemorrhage; duration of hospitalization; and duration of antibiotic use.A total of 3158 individuals from 632 acute‐care hospitals were eligible. The proportion of conservative management versus appendectomy by trimester were 507 (49.1%) versus 525 (50.9%) in the first, 690 (44.6%) versus 856 (55.4%) in the second, and 337 (58.1%) versus 243 (41.9%) in the third. In the second trimester, appendectomy was associated with a higher rate of preterm delivery, preterm labor, or abortion (odds ratio [OR], 2.91 [95% confidence interval (CI), 1.62–5.25]). Antepartum hemorrhage occurred more frequently for appendectomy in the first (OR, 2.12 [95% CI, 1.31–3.43]) and third (OR, 2.43 [95% CI, 1.79–3.31]) trimesters. Appendectomy was associated with a longer duration of hospitalization in the second (2.15 days; 95% CI, 1.14–3.17 days) and third (3.97 days; 95% CI, 2.22–5.71 days) trimesters. Antibiotic use duration was shorter for appendectomy in the first (−1.20 days [95% CI −1.51 to −0.90 days]) and second (−0.61 days [95% CI −0.90 to −0.32 days]) trimesters.Clinical outcomes of acute appendicitis during pregnancy vary by trimester. Considering the appendectomy risks, conservative management may be viable depending on the clinical context and trimester. [ABSTRACT FROM AUTHOR]

This article provides practice guidelines for qualified surgeons on the use of laparoscopic surgery for various conditions related to colorectal cancer. The guidelines recommend laparoscopic surgery for colon cancer due to its comparable long-term results and superior short-term outcomes compared to open surgery. However, the use of laparoscopic surgery for transverse colon and rectal cancer is still controversial. The guidelines also discuss the applicability of laparoscopic surgery based on disease stage, comorbidities, and age. Overall, laparoscopic surgery is considered safe and effective, but individual patient factors should be carefully considered. The article also mentions the use of laparoscopic surgery for acute appendicitis, diverticula of the large intestine, ulcerative colitis, Crohn's disease, elderly patients, obese patients, and Stage IV colorectal cancer, providing insights into the short-term and long-term outcomes of laparoscopic surgery for these conditions. The article concludes that further research is needed, particularly in the area of robotic surgery for colorectal cancer. [Extracted from the article]

ronidazole compared to those who received ciprofloxacin alone. The combination regimen was associated with a lower risk of post-biopsy infection, including sepsis and hospitalization. The study suggests that the addition of metronidazole to the prophylactic antibiotic regimen may be beneficial in reducing infectious complications after TRUS biopsy.The fourth study investigated the impact of preoperative anemia on postoperative outcomes in patients undergoing radical cystectomy for bladder cancer. The study found that preoperative anemia was associated with an increased risk of postoperative complications, including surgical site infection, urinary tract infection, and prolonged hospital stay. The study suggests that preoperative management of anemia may be important in optimizing postoperative outcomes in bladder cancer patients.The fifth study evaluated the efficacy and safety of a new technique called "tubeless" percutaneous nephrolithotomy (PCNL) for the treatment of kidney stones. The study found that tubeless PCNL was associated with shorter hospital stay, less postoperative pain, and faster recovery compared to conventional PCNL with a nephrostomy tube. The study suggests that tubeless PCNL may be a feasible and safe alternative for selected patients with kidney stones.These studies provide valuable insights into various aspects of urological surgery, including treatment options for benign prostatic hyperplasia, the impact of socio-economic factors on the use of erectile dysfunction medication, prophylactic antibiotic regimens for prostate biopsy, the role of preoperative anemia in bladder [Extracted from the article]

Objective: To investigate the psoriatic disease risk among patients with previous appendicitis. Methods: This study was a nationwide population‐based case–control study about the association between the psoriatic disease risk among patients with a history of appendicitis in Taiwan. The study population consisted of newly diagnosed psoriatic disease with at least two outpatient visits, and the control group included those patients without psoriatic disease at the same index date. Patients with a previous diagnosis of appendicitis or who underwent appendectomy surgery prior to their psoriatic disease diagnosis were recorded. The odds ratio of psoriatic disease diagnosis in the two groups with and without a history of appendicitis were analyzed and compared. Results: A total of 48 894 individuals diagnosed with psoriatic disease were matched with 292 656 controls by age and gender. Notably, the proportion of patients with a history of appendicitis or primary appendectomy was significantly elevated among those with psoriatic disease compared with the control cohort (both p <.05). On average, the occurrence of appendicitis preceded the index date by 3.3 ± 2.3 years. Multivariate analysis revealed a heightened incidence rate of psoriatic disease in patients previously diagnosed with appendicitis, periodontal disease, Charlson comorbidity index score (CCIS) ≧1, and ill‐defined intestinal infections. This association persisted after adjusting for confounding factors, such as periodontal disease, CCIS, Salmonella, and ill‐defined intestinal infections. The odds ratios for psoriatic disease in individuals with a history of appendicitis, periodontal disease, CCIS ≧1, and ill‐defined intestinal infections were 1.16, 1.008, 1.69, and 1.23, respectively, with corresponding 95% confidence intervals of 1.03–1.31, 1.05–1.11, 1.65–1.74, and 1.20–1.26. These findings underscore the independent association between appendicitis and subsequent development of psoriatic disease, even after adjusting for relevant comorbidities and potential confounders. Conclusion: Our research illustrates that appendicitis is associated with an increased likelihood of developing a psoriatic disease, despite several limitations. These limitations encompass variables such as dietary and smoking habits, alongside other potential confounding factors that were not fully considered. Moreover, inherent biases in utilizing national health insurance data, such as the absence of laboratory information, as well as the constraints inherent in a retrospective study design, should be acknowledged. [ABSTRACT FROM AUTHOR]

Background: Acute appendicitis is the most common aetiology of acute abdomen in children. Our aim is to describe the accuracy of diagnosis, and complications in a limited resources setting in children between 5 and 14 years old at the only tertiary referral hospital in the West region of Afghanistan. Methods: A retrospective study for a period of 1 year (21 March 2015–20 March 2016). Data was collected from patients' files. Data were analysed by epi info 7. Results: We identified 774 children who had appendectomies at Herat Regional Hospital during the study period with complete records available for analysis. The median age was 11 years [5–14]. The rate of positive appendectomy was 87%. 72% of appendectomies were done within 24 h of the onset of symptoms. Of 675 positive appendectomies, the most common clinical features were migratory abdominal pain (90%), nausea/vomiting (80%), RLQ tenderness (90%), and rebound tenderness (81%). Among the 99 negative appendectomies, the most common signs and symptoms were anorexia 68%, nausea/vomiting 59%, RLQ tenderness 79%, and rebound tenderness 43%. 98% of positive and 71% of negative appendectomies had elevated WBC count. Post appendectomy complications occurred in 9% of our patients mostly commonly intra‐abdominal abscesses (5%). Conclusion: Although the diagnosis of acute appendicitis is challenging in children and may involve sophisticated imaging techniques, in many settings these are unavailable. Classical manifestations such as migratory abdominal pain, abdominal tenderness, nausea, and simple lab tests play a crucial role in the diagnosis of acute appendicitis in low resource environments. [ABSTRACT FROM AUTHOR]

Background: Appendicitis is the commonest paediatric surgical emergency. Adult studies suggest non‐operative management (NOM) may have a place in care. There have been no adequately powered randomized controlled trials in children. Objective: to determine the safety and efficacy of NOM for paediatric simple appendicitis. Methods: A non‐inferiority randomized controlled trial was conducted comparing operative (OM) to NOM of SA in children aged five‐15 years. Primary outcome was treatment success (no unplanned or unnecessary operation, or complication) at 30 days and 12 months, with a non‐inferiority margin of 15%. (anzctr.org.au: ACTRN12616000788471). Results: From 11 June 2016 to 30 November 2020, 222 children were randomized: 94 (42.34%) to OM and 128 (57.66%) to NOM. Non‐inferiority of NOM was not demonstrated at either time point, with 45.67% of NOM patients subsequently undergoing operation. There was no significant difference in complications. Conclusions: While noninferiority was not shown, NOM was safe, with no difference in adverse outcomes between the two groups. Further research to refine the place of NOM of simple appendicitis in children is required, including nuanced patient selection, longer term evaluation, the place of choice, and the acceptability of the treatment for children and their carers. [ABSTRACT FROM AUTHOR]

Key Clinical Message: Meckel's diverticulitis (MD) mimics acute appendicitis with right lower abdominal pain. Clinicians must consider MD in acute abdomen cases to avoid diagnostic delays. Perforated MD can lead to serious complications. Timely use of advanced imaging and surgical assessment is essential for accurate diagnosis and management. Meckel's diverticulum (MD) is a gastrointestinal congenital anomaly that signifies a persistent remnant of the omphalomesenteric duct. While frequently asymptomatic, its complications vary widely, ranging from mild and painless to potentially life‐threatening conditions. This is a case of a 4‐year‐old female patient with sudden abdominal pain and tenderness, with an elusive cause before surgery. The definitive diagnosis of a perforated MD was established during diagnostic laparoscopy due to worsening symptoms. Detecting MD and its potential complications requires a high degree of suspicion. Once recognized, prompt management is essential to prevent further complications. Although perforation is uncommon in MD, its symptoms can mimic acute appendicitis, confusing emergency settings. This article underscores the significance of diagnosing MD, despite its rarity, and emphasizes the necessity for swift treatment upon identification. [ABSTRACT FROM AUTHOR]

Objectives: To describe a systematic scanning approach using anatomical landmarks followed by an assessment of radiology trainees' ability to identify the normal appendix in healthy children. Methods: Uncontrolled pre and post study assessing radiology residents' sonographic skills in detecting the normal appendix in healthy children. Initial questionnaire for the trainees' demographics, perceptions and experiences in detecting the appendix with ultrasound in children followed by a precourse test on healthy volunteers. Hands‐on training was conducted by describing a systematic sonographic approach to identify the appendix using anatomical landmarks, and then a postcourse test was carried out. The primary outcome was unprompted ability to identify the appendix. Subjective self‐scoring of confidence was also recorded. Results: A three‐hour hands‐on workshop was conducted. Sixteen radiology trainees participated and were randomly distributed to four stations, each with different ultrasound machines and healthy volunteers. Fifteen had a precourse assessment, and 12 completed the postcourse assessment. Before the course, 3/15 (20%) identified the appendix, while 10/12 (83%) identified the appendix afterward. After the course, participants perceived finding the appendix easier than before. There was no statistically significant difference in the participants' perceived confidence in detecting the appendix. Conclusions: With the described scanning technique, most of the participants were able to identify the normal appendix after receiving short hands‐on training. This highlights the importance of targeted training of radiology trainees and nonradiologists. [ABSTRACT FROM AUTHOR]

A focussed abdominal ultrasonographic imaging technique was evaluated in five rabbits. Five sick rabbits presented to a veterinary exotics centre were imaged using a rapid, focussed ultrasonographic technique via four acoustic windows, as part of the clinical investigation. During imaging, the rabbits were either fully conscious, or sedated with midazolam if they showed signs of stress. Appendicitis, megacolon, splenic pathology and an intestinal wall abscess were identified using this technique, the diagnosis being confirmed on laparotomy, histopathology or computed tomography. A liver lobe torsion was suspected in one case, with supporting evidence from subsequent monitoring and response to medical management. This rapid ultrasonographic technique identified abnormal abdominal organs providing valuable diagnostic information, without the need for profound sedation or causing undue stress to the patient, demonstrating the potential value of focussed imaging in this species. [ABSTRACT FROM AUTHOR]

Objectives: To determine whether superb microvascular imaging (SMI) provides a more precise delineation between reversible and irreversible stages of uncomplicated acute appendicitis managed non‐operatively. Methods: This prospective clinical study examined pediatric patients with acute appendicitis initially treated non‐operatively and evaluated using power Doppler (PD) and SMI. We determined case severity, monitor appendiceal blood flow (BF), and appendicitis reversibility. Complicated cases were excluded. Severity was classified using B‐mode as well as PD, or SMI: Grade I, smooth wall/normal BF; Grade IIa, irregular wall/increased BF; Grade IIb, irregular wall/decreased BF; and Grade III, absence of wall/loss of BF. Results: This study examined a total of 100 patients with acute appendicitis, after excluding 29 patients. All 10 patients with normal BF on PD (Grade I) showed similar BF on SMI (Grade I). Among 29 patients with increased BF on PD (Grade IIa), corresponding increased BF was noted on SMI (Grade IIa), and all these patients showed full recovery. Of the 55 patients showing decreased BF on PD (Grade IIb), 52 showed increased BF on SMI (Grade IIa). The remaining three patients, identified with an impacted appendicolith, showed decreased BF on SMI (Grade IIb) and experienced treatment failure, subsequently developing abscesses. In all six patients with undetectable BF on PD (Grade III), SMI similarly could not detect appendiceal BF (Grade III), and non‐operative management failed for these patients. Conclusions: SMI offers an objective and effective means of delineating the threshold between reversible and irreversible stages in uncomplicated acute appendicitis following non‐operative management. [ABSTRACT FROM AUTHOR]

Key Clinical Message: Perforation of Meckel's diverticulum (MD) is rare, particularly by foreign body. High index of suspicion and thorough intraoperative assessment is needed in patients undergoing surgery for acute appendicitis, specifically when appendix appears normal. Meckel's diverticulum is the most common congenital anomaly of the gastrointestinal tract. While often asymptomatic, it can present with several complications. Perforation due to foreign body ingestion is rare but can have severe consequences if late diagnosis occurs. A 13‐year‐old male, initially suspected of acute appendicitis, was eventually diagnosed with perforation of MD by a wood splinter‐like foreign body after intraoperative assessment. Histological analysis revealed ectopic colonic tissue within the MD, a finding whose implications are not well understood, in contrast with the well‐established complications associated with ectopic gastric and pancreatic tissues. This case highlights the diagnostic challenges of MD, which can mimic acute appendicitis, emphasizing the need for high suspicion when faced with atypical clinical presentation such as foreign body‐induced perforation. Although surgical resection of asymptomatic MD remains controversial, we recommend a case‐specific approach based on risk factors to guide decision‐making on surgical resection for asymptomatic MD. [ABSTRACT FROM AUTHOR]

Aim: Delays in care may be a driver of inequities in perforated appendicitis rates. The goal of this study was to explore potential causes of delay in care for children with perforated appendicitis. Methods: We conducted an interview study of caregivers of children admitted with perforated appendicitis to a children's hospital between December 2022 and March 2023. Semi‐structured interviews based on an iteratively revised interview guide were conducted in‐person during the child's admission. All interviews were transcribed, coded and underwent a process of thematic analysis. Results: We reached thematic saturation after 12 interviews. The median age for children was 13.5 years, 50% were male, 83% of caregivers self‐identified as White, and one interview required an interpreter. Through thematic analysis, four major themes for potential causes of delay emerged. The first theme of symptom recognition includes delays related to recognising the symptoms, their severity and the need for medical evaluation. The second theme – accessing care – describes delays that occur after a decision was made to seek care until the child was evaluated. The third theme includes delays that occur in making the diagnosis after evaluation. The last theme captures potential delays in definitive treatment after a diagnosis of appendicitis is made. Conclusion: We identify four major themes from the patient and family perspective, each with multiple sub‐themes, for potential delays in definitive care for children with perforated appendicitis. Additional research is needed to further characterise these potential delays and quantify their role in contributing to inequities in perforation rates. [ABSTRACT FROM AUTHOR]

Background: Acute appendicitis remains the most common surgical emergency worldwide. There has been a low uptake of laparoscopic appendicectomy in the South African public sector. Preoperative identification of cases of uncomplicated appendicitis that are amenable to a laparoscopic approach may facilitate the implementation of laparoscopic appendicectomy programs in training hospitals. With limited access to preoperative imaging, alternative strategies for this preoperative prediction are needed. Methods: A retrospective audit of patients over the age of 12 years with a histologically confirmed diagnosis of acute appendicitis over a 5‐year period was performed. Patients were categorized as uncomplicated or complicated appendicitis and C‐reactive protein (CRP) and white cell count (WCC) reviewed. Receiver operating characteristics curves were constructed for these blood tests and acute appendicitis severity. Youden's J statistic was used to determine optimal cut off values for diagnosing complicated appendicitis. Results: 358 patients had confirmed appendicitis and complete blood results. Of these, 189 (52.79%) had complicated appendicitis with a 40.22% perforation rate. Median CRP in uncomplicated and complicated groups were 68 mg/L (IQR 19–142) and 216 mg/L (IQR 103–313) with an area under the curve (AUC) of 0.75 (95% CI: 0.70–0.80). The median WCC in the two groups were 12.6 × 109 cells/L (IQR 9.9–15.6) and 14.4 × 109 cells/L (IQR 11.5–18.28) with an AUC of 0.61 (95% CI: 0.56–0.67). The optimal cut off value for CRP was found to be 110 mg/L with a sensitivity of 74.74% and specificity of 69.23%. Conclusion: A cutoff value of 110 mg/dl CRP can distinguish patients with early appendicitis from those with complicated disease and when used in conjunction with clinical assessment may help identify patients in whom laparoscopic appendicectomy is appropriate. [ABSTRACT FROM AUTHOR]

Background: Controversies remain on the diagnostic strategy in suspected AA, considering the different settings worldwide. Material and Methods: A prospective observational international multicentric study including patients operated for suspected AA with a definitive histopathological analysis was conducted. Three groups were analyzed: (1) No radiology; (2) Ultrasound, and (3) Computed tomography. The aim was to analyze the performance of three diagnostic schemes. Results: Three thousand and one hundred twenty three patients were enrolled; 899 in the no radiology group, 1490 in the US group, and 734 in the CT group. The sex ratio was in favor of males (p < 0.001). The mean age was lower in the no radiology group (24 years) compared to 28 and 38 years in US and CT‐scan groups, respectively (p < 0.001). Overall, the negative appendectomy rate 3.8%: no radiology group (5.1%) versus US (2.9%) and CT‐scan (4.1%) (p < 0.001). The sensitivity and specificity analysis showed the best balance in clinical evaluation + score + US. These data reach the best results in those patients with an equivocal Alvarado score (4–6). Inverse probability weighting (IPW), showed as the use of ultrasound, is significantly associated with an increased probability of formulating the correct diagnosis (p 0.004). In the case of a CT scan, this association appears weaker (p 0.08). Conclusion: The association of clinical scores and ultrasound seems the best strategy to reach a correct preoperative diagnosis in patients with clinical suspicion of AA, even in those population subgroups where the clinical score may have an equivocal result. This strategy can be especially useful in low‐resource settings worldwide. CT‐scan association may improve the detection of patients who may potentially be submitted to conservative treatment. [ABSTRACT FROM AUTHOR]

Background: Epiploic appendagitis (EPA) is an uncommon emergency surgical condition that causes acute abdominal pain, rendering a list of differential diagnoses. Therefore, careful examination and imaging tools are required. EPA is a self‐limiting condition that can be resolved in 1–2 weeks and rarely needs surgical intervention. Its low incidence makes EPA less well‐known among the public and some medical professionals, and it is frequently under‐diagnosed. We aimed to explore the incidence, clinical presentation, modalities of imaging to diagnose and options for treating EPA. Methods: An observational retrospective analysis was conducted between 2016 and 2022 at a tertiary hospital in an Arab Middle Eastern country. Results: There were 156 EPA cases diagnosed over six years, with a mean age of 33 years. Males represented 82% of the cohort. The entire cohort was treated non‐operatively except for eight patients who had surgical intervention using open or laparoscopic surgery. The diagnosis was made by a computerized tomographic scan (CT). However, plain X‐ray, abdominal ultrasound, and magnetic resonance imaging (MRI) were performed initially in a few selected cases to rule out other conditions. No specific blood test indicated EPA; however, a histopathology examination was diagnostic. No mortality was reported in the study cohort. Conclusion: This is the most extensive study analyzing EPA patients from the Middle East. EPA is a rare and mostly self‐limiting acute abdominal disorder; however, early ultrasound and CT scan can pick it up quickly after a high index of suspicion. [ABSTRACT FROM AUTHOR]

Purpose: To investigate the accuracy of point‐of‐care ultrasound (PoCUS) in diagnosing acute appendicitis in children; to evaluate the concordance between PoCUS performed by a pediatric emergency physician (PedEm) and ultrasonography (US) performed by a radiologist; to draw a "learning curve." Methods: We prospectively enrolled children aged 0–14 years old led to the Emergency Department of Regina Margherita Children's Hospital, from January 2021 to June 2021, with suspected acute appendicitis. PoCUS was performed by a single trained PedEm, blindly to the radiologist's scan. A "self‐assessment score" and the "time of duration of PoCUS" were recorded for each patient. Final diagnosis of appendicitis was made by a pediatric surgeon. Results: We enrolled 62 children (2–14 years). Overall sensitivity of PoCUS was 88%, specificity 90%; PPV 90.6%, and NPV 86.6%. Global concordance between the PedEm and the radiologist was good/excellent (k 0.74). The mean duration of PoCUS significantly decreased during the study period, while the self‐assessment score increased. Conclusion: This is a preliminary study that shows the effectiveness of PoCUS in diagnosing acute appendicitis; furthermore, it shows how the PedEm's performance may improve over time. The learning curve showed how the experience of the PedEm affects the accuracy of PoCUS. [ABSTRACT FROM AUTHOR]

The study published in Acta Paediatrica aimed to differentiate between Campylobacter enteritis and acute appendicitis in children presenting with abdominal pain. The research, conducted in a pediatric emergency department, analyzed data from children diagnosed with Campylobacter or appendicitis from June 2020 to June 2023. Findings indicated that certain clinical and laboratory parameters, such as age, symptoms, and inflammatory markers, could help distinguish between the two conditions, potentially reducing unnecessary imaging and surgical interventions. The study highlighted the importance of accurate diagnosis to prevent exposure to ionizing radiation and unnecessary surgical procedures in pediatric patients. [Extracted from the article]

Summary: Appendicectomy is a common procedure in children with a low risk of mortality, however, complication rates and risk factors are largely unknown. This study aimed to characterise the incidence and epidemiology of postoperative complications in children undergoing appendicectomy in the UK. This multicentre prospective observational cohort study, which included children aged 1–16 y who underwent surgery for suspected appendicitis, was conducted between November 2019 and January 2022. The primary outcome was 30‐day postoperative morbidity. Data collected included: patient characteristics; comorbidities; and physiological status. Multivariable regression analysis was used to identify independent risk factors for poor outcomes. Data from 2799 children recruited from 80 hospitals were analysed, of which 185 (7%) developed postoperative complications. Children from black and 'other' minority ethnic groups were at significantly higher risk of poor outcomes: OR (95%CI) 4.13 (1.87–9.08), p < 0.001 and 2.08 (1.12–3.87), p = 0.021, respectively. This finding was independent of socio‐economic status and type of appendicitis found on histology. Other risk factors for complications included: ASA physical status ≥ 3 (OR (95%CI) 4.05 (1.70–9.67), p = 0.002); raised C‐reactive protein (OR 95%CI 1.01 (1.00–1.01), p < 0.001); pyrexia (OR (95%CI) 1.77(1.20–2.63), p = 0.004); and peri‐operative oxygen supplementation (OR (95%CI) 4.20 (1.44–12.24), p = 0.009). In the UK NHS, which is a universally accessible healthcare system, ethnicity, but not socio‐economic status, was associated with an increased risk of postoperative complications in children having surgery for acute appendicitis. Further evaluations and interventions are required to address this health inequality in keeping with NHS and international priorities. [ABSTRACT FROM AUTHOR]

Introduction: The accessory appendicular artery (AAA) is an accessory source of blood supply to the appendix. Its existence and potential point of origin are seldom addressed in the literature. Methods: To fill this knowledge gap, we performed a systematic review of all available studies involving both cadaveric and surgical specimens and documented the presence and the origin of the AAA, following the guidelines outlined in the preferred reporting items for systematic reviews and meta‐analysis (PRISMA) statement. Results: Eleven studies, with an overall of 604 specimens were included. Our research revealed that the AAA is notably absent in most cases (83.6%). When present, it most commonly originates from the posterior cecal artery (12.4%), followed by the descending branch of the ileocolic artery (2%), and the ileal branch of the ileocolic artery (0.7%). Instances of origin from the anterior cecal, common cecal, or the ileocolic trunk were even more infrequent. Based on our observations, we introduced a new simplified classification system. Discussion: The effect of an accessory artery on the process of appendicitis remains to be clarified. We firmly recommend that surgeons should consider the possible presence and various origins of the AAA during appendectomy procedures to avoid serious complications. [ABSTRACT FROM AUTHOR]

The role of appendectomy in the pathogenesis of colorectal cancer (CRC) is a recent topic of contention. Given that appendectomy remains one of the most commonly performed operations and a first‐line management strategy of acute appendicitis, it is inherently crucial to elucidate the association between prior appendectomy and subsequent development of CRC, as there may be long‐term health repercussions. In this review, we summarize the data behind the relationship of CRC in post‐appendectomy patients, discuss the role of the microbiome in relation to appendectomy and CRC pathogenesis, and provide an appraisal of our current understanding of the function of the appendix. We seek to piece together the current landscape surrounding the microbiome and immunological changes in the colon post‐appendectomy and suggest a direction for future research involving molecular, transcriptomic, and immunologic analysis to complement our current understanding of the alterations in gut microbiome. [ABSTRACT FROM AUTHOR]

Backgrounds: We aimed to investigate surgeons in training knowledge of clinical decision rules (CDR) for diagnosing appendicitis and their attitudes toward implementing them. Methods: We included surgeons in training practicing in East Denmark who independently could decide to perform a diagnostic laparoscopy for suspected appendicitis. The survey was developed in Research Electronic Data Capture and face‐validated before use. It consisted of three parts: (1) the characteristics of the surgeons, (2) their diagnostic approach, and (3) their knowledge and attitude toward introducing CDR in the clinic. Data were collected in January 2023. Results: We achieved 83 (90%) responses, and 52% of surgeons in training believed that appendicitis was difficult to diagnose. Their diagnostic approach mostly included symptoms and physical examinations for abdominal pain, and C‐reactive protein. A total of 48% knew of at least one clinical decision rule, and 72% had never used a clinical decision rule. Regarding the necessity of CDR in clinical practice, surgeons in training options were divided into thirds: not needed, neither needed nor not needed, and needed. Surgeons in training indicated that CDR needed to be validated and easily applied before they would implement them. Conclusion: Approximately 3/4 of surgeons in training had never utilized a clinical decision rule to diagnose appendicitis, and only half knew of their existence. The symptoms and findings incorporated in most CDR aligned with their diagnostic approach. They were conflicted if CDR needed to be implemented in clinical practice. [ABSTRACT FROM AUTHOR]

There is much controversy about the application of abdominal irrigation in the prevention of wound infection (WI) and intra‐abdominal abscess (IAA) in the postoperative period. Therefore, we performed a meta‐analysis of the effect of suctioning and lavage on appendectomy to assess the efficacy of either suctioning or lavage. Data were collected and estimated with RevMan 5.3 software. Based on our research, we found 563 publications in our database, and we eventually chose seven of them to analyse. The main results were IAA after the operation and WI. Inclusion criteria were clinical trials of an appendectomy with suctioning or lavage. In the end, seven trials were chosen to meet the eligibility criteria, and the majority were retrospective. The results of seven studies showed that there was no statistically significant difference between abdominal lavage and suctioning treatment for post‐operative WI (OR, 1.82; 95% CI, 0.40, 2.61; p = 0.96); There was no statistically significant difference between the two groups in the risk of postoperative abdominal abscess after operation (OR, 1.16; 95% CI, 0.71, 1.89; p = 0.56). No evidence has been found that the use of abdominal lavage in the treatment of postoperative infectious complications after appendectomy is superior to aspiration. [ABSTRACT FROM AUTHOR]

This study aimed to explore the impact of clinical nursing pathway applied to acute appendicitis surgery on patients' postoperative wound infections and complications. A computerised search of PubMed, Cochrane Library, Web of Science, EMBASE, Wanfang, Chinese Biomedical Literature Database and China National Knowledge Infrastructure was conducted and supplemented by a manual search, from database inception to October 2023, to collect randomised controlled trials (RCTs) on the application of clinical nursing pathways to acute appendicitis surgery. Literature screening, data extraction and quality assessment of the included literature were carried out independently by two researchers. RevMan 5.4 software was applied for data analysis. Twenty‐one RCTs with a total of 2408 patients were finally included. The analysis revealed the implementation of clinical nursing pathway could effectively reduce the incidence of wound infection (OR = 0.26, 95% CI: 0.15–0.46, p < 0.001) and postoperative complications (OR = 0.20, 95% CI: 0.15–0.27, p < 0.001), as well as shorten the hospital length of stay (MD = −3.26, 95% CI: −3.74 to −2.79, p < 0.001) and accelerated the time to first ventilations (MD = −14.85, 95% CI: −21.56 to −8.13, p < 0.001), as well as significantly improved patient satisfaction (OR = 5.52, 95% CI: 3.52–8.65, p < 0.001) in patients undergoing surgery for acute appendicitis. The application of clinical nursing pathway in acute appendicitis surgery can significantly reduce postoperative wound infection and complications, and at the same time can shorten the hospital length of stay as well as improve the satisfaction of patients. [ABSTRACT FROM AUTHOR]

Operative site wound infection is one of the most frequent infections in surgery. A variety of studies have shown that the results of laparoscopy might be superior to those of an open procedure. Nevertheless, there is still a lack of clarity as to whether there is a difference between open and laparoscopy with respect to the occurrence of wound infections in different paediatric operations. In this review, we looked at randomized, controlled studies that directly measured the rate of wound infection following an appendectomy with a laparoscope. We looked up four main databases for randomized, controlled studies that compare the treatment of paediatric appendicitis with laparoscopy. The surgeries included appendectomy. Through our search, we have determined 323 related papers and selected five qualified ones to be analysed according to the eligibility criteria. Five trials were also assessed for the quality of the documents. In the 5 trials, there were no statistically significant differences in the incidence of post‐operative wound infection among the paediatric appendectomy and the open‐access group (odds ratio [OR], 0.63; 95% confidence interval [CI], 0.34–1.15, p = 0.13). The four trials did not show any statistically significant difference in abdominal abscesses among the laparoscopic and open‐access treatment groups (OR, 1.64; 95% CI, 0.90–3.01, p = 0.11). The four trials did not reveal any statistically significant difference in operating time (mean difference, −4.36; 95% CI, −17.31 to 8.59, p = 0.51). In light of these findings, the use of laparoscopy as compared with the open‐approach approach in paediatric appendectomies is not associated with a reduction in the risk of wound infection. [ABSTRACT FROM AUTHOR]

Background: Appendicitis is a common surgical condition that requires urgent medical attention. Recent advancements in artificial intelligence and large language processing, such as ChatGPT, have demonstrated potential in supporting healthcare management and scientific research. This study aims to evaluate the accuracy and comprehensiveness of ChatGPT's knowledge on appendicitis management. Methods: Six questions related to appendicitis management were created by experienced RACS qualified general surgeons to assess ChatGPT's ability to provide accurate information. The criteria of ChatGPT answers' accuracy were compared with current healthcare guidelines for appendicitis and subjective evaluation by two RACS qualified General Surgeons. Additionally, ChatGPT was then asked to provide five high level evidence references to support its responses. Results: ChatGPT provided clinically relevant information on appendicitis management, however, was inconsistent in doing so and often provided superficial information. Further to this, ChatGPT encountered difficulties in generating relevant references, with some being either non‐existent or incorrect. Conclusion: ChatGPT has the potential to provide timely and comprehensible medical information on appendicitis management to laypersons. However, its issue of inaccuracy in information and production of non‐existent or erroneous references presents a challenge for researchers and clinicians who may inadvertently employ such information in their research or healthcare. Therefore, clinicians should exercise caution when using ChatGPT for these purposes. [ABSTRACT FROM AUTHOR]

This study aimed to comprehensively evaluate the effects of evidence‐based nursing (EBN) intervention on wound infection and postoperative complications in patients after appendectomy for acute appendicitis (AA), with the expectation of providing a theoretical basis for postoperative care in AA. Randomised controlled trials (RCTs) on the postoperative application of EBN in patients with AA were searched in PubMed, Web of Science, Cochrane Library, Embase, China Biomedical Literature Database, Wanfang and China National Knowledge Infrastructure from the inception of databases to October 2023. Two authors screened and evaluated the literature based on the inclusion and exclusion criteria, and data were extracted from the final included literature. Stata software (version 17.0) was employed for data analysis. In total, 29 RCTs involving 2848 patients with AA were included, with 1424 in the EBN group and 1424 in the conventional care group. The analyses revealed that patients with AA who experienced EBN were significantly less likely to develop postoperative wound infections (odds ratio [OR] = 0.23, 95% confidence intervals [CIs]: 0.14–0.38, p < 0.001) and postoperative complications (OR = 0.20, 95% CI: 0.15–0.26, p < 0.001) as opposed to conventional care. Available evidence suggests that EBN can effectively reduce the risk of wound infection and postoperative complications in patients undergoing appendectomy for AA, thereby improving patient prognosis. This finding is worth promoting in the clinical practice. [ABSTRACT FROM AUTHOR]

This article discusses the history, diagnosis, and treatment of acute appendicitis. It highlights the shift in medical practice from mandatory surgery to a more conservative approach, considering the potential complications of unnecessary appendectomy. The use of clinical scores and ultrasound is recommended as the most appropriate preoperative strategy for diagnosing acute appendicitis. The article emphasizes the importance of tailoring the diagnostic pathway based on individual factors such as age, sex, and clinical symptoms. The authors also mention the potential benefits of using artificial intelligence in diagnosing and guiding treatment for acute appendicitis. [Extracted from the article]

Introduction: Acute appendicitis (AA) requires a prompt diagnosis. According to postoperative pathological results, a significant number of appendectomies are performed on a normal appendix (NA). The aim of this study is to evaluate the role of preoperative inflammatory markers in supporting and improving the clinical diagnosis of AA, extracting more information from CBC parameters. Methods: The study is a retrospective one. The histopathological results of operated appendix from 102 patients, who underwent appendectomy for clinically suspected AA, were extracted from the Galilee Medical Center systems. Two patient groups (NA and true AA) were compared for neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR), monocyte to lymphocyte ratio (MLR) and mean platelet volume (MPV). The obtained data were statistically analyzed, using the independent sample t test and Mann–Whitney test. Category data have been compared among groups with the chi‐squared test. The primary endpoint of our research was to assess the predictive power of blood biomarkers. Results: Patients with suspected AA, based on clinical picture and contrast enhanced computed tomography (CECT), and with MLR‐value ≥0.3357 were 5.25 times more likely than normal to have AA. Patients with NLR‐value ≥3.2223 were 7 times more likely than normal to have AA. The differences in PLR and MPV values were not statistically significant. Conclusions: The NLR and MLR biomarkers can assist in diagnosis of AA. This can be particularly helpful in cases where CECT is contraindicated, as in pregnant women or children. [ABSTRACT FROM AUTHOR]

Introduction: Correct diagnosis of acute appendicitis may sometimes be challenging. The Negative appendectomy rate (NAR) has declined in the recent years in Europe and USA, in part due to better diagnostic imaging tools. The aim of this study was to examine the rates of negative appendectomy in our institution, investigate trends in its incidence, and identify possible predicting factors. Methods: A retrospective cohort study, including all patients younger than 18 years of age who underwent an appendectomy between 2007 and 2021 in a single tertiary medical center. Data regarding patient's demographics, laboratory and imaging results, pathological results and clinical outcome were collected. Results: Between 2007 and 2021, a total of 3937 pediatric patients underwent appendectomy due to a working diagnosis of acute appendicitis. Overall, 143 patients (3.6%) had normal appendix on pathological examination. However, in the last 5 years, the rate of normal appendix was 1.9%, together with an increased rate of pre‐operative imaging (from 40% to nearly 100%). Conclusion: Low NAR under 2% is an achievable benchmark in the era of accessible pre‐operative imaging. In unequivocal cases, a secondary survey that includes repeated physical examination, blood work and imaging is recommended and may result in near‐zero rates of NAR. [ABSTRACT FROM AUTHOR]

Key Clinical Message: Patients mimicking appendicitis symptoms in a rural setting or those post‐appendectomy, indicating cecal volvulus, should always be considered. Swift action can prevent catastrophic consequences. We present a case of a 14‐year‐old female who initially underwent open appendectomy for acute appendicitis and subsequently experienced symptoms of abdominal distention, vomiting, and fever. Her condition deteriorated following the appendectomy, despite a prior appendectomy for similar symptoms at a different facility. A computed tomography (CT) scan identified cecal volvulus as the underlying issue. This led to the performance of a laparotomy, cecopexy, and decompressive ileostomy. After six weeks, ileostomy closure was successfully carried out, and the patient currently enjoys good health. This case highlights the significance of considering uncommon factors as potential contributors to postoperative complications in young patients. [ABSTRACT FROM AUTHOR]

Background: Appendicitis in pancreatic transplant recipients can be challenging to diagnose and manage. Incidental appendicectomy (IA) during pancreas transplantation obviates the risk of appendicitis but potentially at the cost of increased operating time or early post‐operative complications. This study reviewed the value of IA at a single center. Methods: This was a retrospective study of patients who underwent a pancreas transplant in our unit from January 1st, 2012 to December 31st, 2020, with end of follow‐up on May 21st, 2023; recipients were grouped by whether or not an IA was performed during pancreas transplantation. Donor, recipient, operative, and graft outcomes were compared between the two groups. Post‐transplant complications related to appendiceal pathology (or IA) were recorded and classified. Results: Two hundred forty‐three patients underwent a pancreas transplant; 227 (93%) patients had an appendix in situ at transplantation, and of these 53 (23%) underwent an IA and 174 (77%) did not. There were no statistically significant differences in operative time (p =.06) or hospital stay (p =.50) between the two groups. In the IA cohort, there were no Clavien‐Dindo Grade III‐V complications relating to the appendicectomy. In those that did not undergo an IA, two patients (1%) subsequently required appendicectomy due to appendicitis. Comparison of pancreatic graft survival showed no statistically significant difference between the groups (p =.44). Conclusions: This study suggests that IA is effective at reducing risks of post‐transplant appendiceal complications without significantly prolonging inpatient stay or impairing graft survival. These data support the consideration of undertaking an IA for all patients undergoing a pancreas transplant. [ABSTRACT FROM AUTHOR]

Background: Acute appendicitis is one of the most common abdominal emergencies, with management approaches that vary depending on the available resources and setting. However, there is a lack of studies on the differences of surgical outcomes and quality of care between tertiary care hospitals and regional hospitals. Methods: This multicenter retrospective study included 2158 consecutive adult patients between January 2014 and June 2018 at three hospitals. The patient cohort was divided into regional hospital group (N = 1223) and tertiary care hospital group (N = 935). Baseline characteristics and perioperative outcomes were compared, and factors associated with surgical delay and postoperative complication were investigated. Results: Patients in tertiary care hospital group had longer surgical waiting time (17.3 vs. 12.0 h, p < 0.001), higher risks of surgical delay exceeding 24 h (OR = 2.94, 95% CI 2.17–4.01, p < 0.001), longer operation time (64 vs. 50 min, p < 0.001), more appendix perforation (22.4 vs. 13.3%, p < 0.001), and higher hospital cost compared with regional hospital group. In multivariate analysis, factors associated with surgical delay were tertiary care hospital (OR = 2.94, 95% CI 2.18–4.01, p < 0.001) and delay diagnosis (OR = 18.7, 95% CI 11.7–30.1, p < 0.001), while those associated with postoperative complications were older age (OR = 1.02, 95% CI 1.00–1.04, p = 0.013), male sex (OR = 2.38, 95% CI 1.11–5.52, p = 0.031), surgical delay (OR = 2.99, 95% CI 1.30–6.47, p = 0.007), and appendix perforation (OR = 5.61, 95% CI 2.72–11.85, p < 0.001). Conclusions: Patients at tertiary care hospitals had longer waiting time, more surgical delays, and appendix perforations, and these were risk factors of postoperative complications. Establishing an effective referral system to redirect appendicitis patients with less complex medical histories from tertiary care hospitals to regional hospitals may enhance the quality of patient care and outcomes, while also reducing medical costs. [ABSTRACT FROM AUTHOR]

Background: Appendicitis is one of the most common emergency surgical conditions worldwide. Delays in accessing appendectomy can lead to complications. Evidence on these delays in low- and middle-income countries (LMICs) is lacking. The aim of this review was to identify and synthesise the available evidence on delays to accessing appendectomy in LMICs. Methods: This scoping review followed the Preferred Reporting Items for Systematic Reviews and Meta-analysis Extension for Scoping Reviews framework. The delays and their interconnectivity in LMICs were synthesised and interpreted using the Three Delays framework. We reviewed Africa Wide EBSCOhost, PubMed–Medline, Scopus, Web of Science, African Journals Online (AJOL), and Bioline databases. Results: Our search identified 21 893 studies, of which 78 were included in the final analysis. All of the studies were quantitative. Fifty per cent of the studies included all three types of delays. Delays in seeking care were influenced by a lack of awareness of appendicitis symptoms, and the use of self and alternative medication, which could be linked to delays in receiving care, and the barrier refusal of medical treatment due to fear. Financial concerns were a barrier observed throughout the care pathway. Conclusion: This review highlighted the need for additional studies on delays to accessing appendectomy in additional LMICs. Our review demonstrates that in LMICs, persons seeking appendectomy present late to health-care facilities due to several patient-related factors. After reaching a health-care facility, accessing appendectomy can further be delayed owing to a lack of adequate hospital resources. [ABSTRACT FROM AUTHOR]

Background: Many potentially treatable non-congenital and non-traumatic surgical conditions can occur during the first 8000 days of life and an estimated 85% of children in low- and middle-income countries (LMICs) will develop one before 15 years old. This review summarizes the common routine surgical emergencies in children from LMICs and their effects on morbidity and mortality. Methods: A narrative review was undertaken to assess the epidemiology, treatment, and outcomes of common surgical emergencies that present within the first 8000 days (or 21.9 years) of life in LMICs. Available data on pediatric surgical emergency care in LMICs were aggregated. Results: Outside of trauma, acute appendicitis, ileal perforation secondary to typhoid fever, and intestinal obstruction from intussusception and hernias continue to be the most common abdominal emergencies among children in LMICs. Musculoskeletal infections also contribute significantly to the surgical burden in children. These "neglected" conditions disproportionally affect children in LMICs and are due to delays in seeking care leading to late presentation and preventable complications. Pediatric surgical emergencies also necessitate heavy resource utilization in LMICs, where healthcare systems are already under strain. Conclusions: Delays in care and resource limitations in LMIC healthcare systems are key contributors to the complicated and emergent presentation of pediatric surgical disease. Timely access to surgery can not only prevent long-term impairments but also preserve the impact of public health interventions and decrease costs in the overall healthcare system. [ABSTRACT FROM AUTHOR]

Objective: This study aims to construct an artificial intelligence (AI) model capable of effectively discriminating between abdominal Henoch‐Schönlein purpura (AHSP) and acute appendicitis (AA) in pediatric patients. Methods: A total of 6965 participants, comprising 2201 individuals with AHSP and 4764 patients with AA, were enrolled in the study. Additionally, 53 laboratory indicators were taken into consideration. Five distinct artificial intelligence (AI) models were developed employing machine learning algorithms, namely XGBoost, AdaBoost, Gaussian Naïve Bayes (GNB), MLPClassifier (MLP), and support vector machine (SVM). The performance of these prediction models was assessed through receiver operating characteristic (ROC) curve analysis, calibration curve assessment, and decision curve analysis (DCA). Results: We identified 32 discriminative indicators (p <.05) between AHSP and AA. Five indicators, namely the lymphocyte ratio (LYMPH ratio), eosinophil ratio (EO ratio), eosinophil count (EO count), neutrophil ratio (NEUT ratio), and C‐reactive protein (CRP), exhibited strong performance in distinguishing AHSP from AA (AUC ≥ 0.80). Among the various prediction models, the XGBoost model displayed superior performance evidenced by the highest AUC (XGBoost = 0.895, other models < 0.89), accuracy (XGBoost = 0.824, other models < 0.81), and Kappa value (XGBoost = 0.621, other models < 0.60) in the validation set. After optimization, the XGBoost model demonstrated remarkable diagnostic performance for AHSP and AA (AUC > 0.95). Both the calibration curve and decision curve analysis suggested the promising clinical utility and net benefits of the XGBoost model. Conclusion: The AI‐based machine learning model exhibits high prediction accuracy and can differentiate AHSP and AA from a data‐driven perspective. [ABSTRACT FROM AUTHOR]

Objective: To investigate the incidence of occult appendiceal neoplasm in patients aged 40 years and over who underwent appendicectomy for appendicitis. Methods: The clinical coding electronic database was used to identify patients aged 40 years and over who were diagnosed with appendicitis from September 2010 to September 2022. Patients were included if they were managed operatively. Design: Retrospective cohort study. Setting: Modified Monash category 3 (large rural town). Participants: Patients aged 40 years and over undergoing appendicectomy for appendicitis. Main Outcome Measures: Incidence of appendiceal neoplasm within appendicectomy specimen. Results: A total of 279 patients aged 40 years and over underwent appendicectomy, with a median age of 53 years (range 40–95). Nineteen patients (7%) were found to have a primary neoplastic lesion within the appendix: seven neuroendocrine neoplasms (37%), six sessile serrated lesions (32%), two colonic‐type adenocarcinoma (11%), two goblet cell adenocarcinoma (11%) and two appendiceal mucinous neoplasms (11%). Additionally, one patient had a metastatic adenocarcinoma of pancreaticobiliary aetiology. Conclusions: Occult appendiceal neoplasm was higher than reported in the literature in our cohort. This would support appendicectomy as the treatment of choice for patients aged 40 years and over with acute appendicitis and caution against nonoperative management in this demographic. [ABSTRACT FROM AUTHOR]

In this meta‐analysis, we comprehensively evaluated the effect of endoscopic retrograde appendicitis therapy (ERAT) on surgical site infections and other perioperative outcomes in patients with acute appendicitis. Relevant studies on ERAT for acute appendicitis were retrieved from PubMed, EMBASE, Web of Science, China National Knowledge Infrastructure, and Wanfang Data, from database inception to June 2023. Statistical analyses were performed using RevMan 5.4. Heterogeneity among the included studies was analysed, and odds ratios (ORs) or standardised mean differences (SMDs), along with their respective 95% confidence intervals (CIs), were calculated. In total, 24 studies involving 1937 patients were included in the meta‐analysis. ERAT reduced the surgical duration (SMD: −1.70, 95% CI: −2.24 to −1.16, p < 0.001) and length of hospital stay (SMD: −2.09, 95% CI: −2.64 to −1.53, p < 0.001) significantly more than open appendectomy (OA) did. Furthermore, ERAT decreased the incidence of surgical site wound infections (OR: 0.22, 95% CI: 0.13–0.37, p < 0.001) and postoperative complications (OR: 0.16, 95% CI: 0.11–0.21, p < 0.001) more than OA did. This study demonstrated that ERAT is a safe and effective endoscopic treatment modality for acute appendicitis, contributing to a significant reduction in the surgical duration, length of hospital stay, and incidence of surgical site wound infections and postoperative complications. Hence, ERAT has clinical significance and the potential for further application and dissemination. [ABSTRACT FROM AUTHOR]

Background: Despite the human immunodeficiency virus (HIV) being the most common comorbidity in South African surgical patients, its impact on appendicitis has not been well-described. We aimed to determine HIV status' influence on patients' presentation, assessment, management and outcomes with acute appendicitis. Methods: The retrospective chart review included all patients aged 12 years and older who were HIV-positive or HIV-negative and presented with acute appendicitis between 1 January 2013 and 31 December 2019. The primary outcome measure was survival to discharge. Secondary outcomes included analysis of the presentation (vital signs), assessment (biochemical, inflammatory markers) and management (intraoperative anatomical severity grading, length of hospital stay). Results: Of the 1096 patients with appendicitis, 196 (17.9%) were HIV-positive, and CD4 counts were available for 159. The median age was 23 years, with the HIV-positive patients being older and HIV-negative group having more males (58.7%). While the HIV-positive patients had a longer median length of hospital stay, there was no statistically significant difference in the two groups' incidence of high-grade appendicitis (p = 0.670). The HIV-positive patients had a higher median shock index (OR 7.65; 95% [CI 2.042–28.64]) than their HIV-negative counterparts. HIV-positivity had a significant association with mortality (OR 9.56; 95% CI [1.68–179.39]), and of the seven HIV-positive patients who died, 66.7% (n = 4) had a CD4 < 200 cells/mm3 (OR 8.6; 95% CI [1.6–63.9]). Conclusion: HIV-positive patients, those with CD4 < 200 cells/mm3 or not on ART, have increased mortality risk and may benefit from increased perioperative surveillance. Patients with an unknown HIV status in a high-prevalence population should be offered HIV testing to risk stratify more accurately. [ABSTRACT FROM AUTHOR]

Introduction: Acute appendicitis is a common surgical emergency. This study aims to determine whether there are any delays in patients attending the emergency department, potentially leading to an increase in the rates of complicated appendicitis and post-operative complications during the fifth wave of the coronavirus disease 2019 (COVID-19) pandemic in a local cluster in Hong Kong. Methods: In this retrospective cohort study, we analysed 138 patients diagnosed with acute appendicitis during the fifth wave of the COVID-19 pandemic and pre-COVID-19 period. The main study parameters were the duration between the onset of symptoms and attendance to the accident and emergency department, severity of appendicitis, post-operative complication(s), operation time and total hospital length of stay. Results: There was no delay in presentation between the two groups of patients. The rates of complicated appendicitis and post-operative complications were comparable between the two groups. There was a significantly shorter length of stay for patients with acute appendicitis patients during the fifth wave of the pandemic. Conclusion: The perspective of the general public towards the COVID-19 pandemic is changing. Increased understanding of the COVID-19 infection and availability of antiviral medications against COVID-19 could be useful to eliminate patient's anxiety when attending medical care in public hospitals. [ABSTRACT FROM AUTHOR]

Objectives: The accuracy of ultrasound in the detection of appendicitis in pregnant women was examined in a meta‐analysis. Methods: Pregnant women with suspected acute appendicitis were evaluated using ultrasound in a systematic search of PubMed, EMBASE, and Cochrane Library databases from January 1, 2011 to August 10, 2023. The sensitivity and specificity values and diagnostic odds ratios were obtained using the pooled data. Results: A total of 239 patients were studied in four relevant investigations. Ultrasonography has a sensitivity of 56% and a specificity of 88% for the diagnosis of acute appendicitis, with an area under the receiver operating characteristic curve of 0.66%. Ultrasonography had a positive likelihood ratio of 4.65 (95% confidence interval, 1.42–15.23) and a negative likelihood ratio of 0.50 (95% confidence interval, 0.41–0.62). There was no evidence of publication bias (p = 0.93). Conclusions: Ultrasound has moderate sensitivity for identifying appendicitis in pregnant women and may be utilized as an alternative diagnostic method. [ABSTRACT FROM AUTHOR]

Cancer occurrence in a blind loop is extremely rare. An 86-year-old Japanese woman underwent colonoscopy for tarry stools and weight loss; it revealed a bypass of the transverse colon and small intestine, cecal cancer, and a polyp. She had suffered from acute appendicitis and had undergone two surgeries at age 25: an appendectomy and then a bypass surgery between the transverse colon and the small intestine. We performed a laparoscopy-assisted ileocecal resection for the cancer and polyp in the blind loop with an end-to-side instrumental anastomosis. The pathological examination demonstrated that the cancer was medullary carcinoma (T2, N0, M0, Stage I) and the polyp was tubular adenoma. Two months have passed since the patient's discharge, and she is free of abdominal complaints. Our literature search identified 10 cases of cancer in a blind loop. Laparoscopy-assisted surgery may be possible in patients who have undergone blind-loop surgery. [ABSTRACT FROM AUTHOR]

Introduction: Non-operative management (NOM) of uncomplicated acute appendicitis is a well-established alternative to upfront surgery. The administration of intravenous broad-spectrum antibiotics is usually performed in hospital, and only one study described outpatient NOM. The aim of this multicentre retrospective non-inferiority study was to evaluate both safety and non-inferiority of outpatient compared to inpatient NOM in uncomplicated acute appendicitis. Methods: The study included 668 consecutive patients with uncomplicated acute appendicitis. Patients were treated according to the surgeon's preference: 364 upfront appendectomy, 157 inpatient NOM (inNOM), and 147 outpatient NOM (outNOM). The primary endpoint was the 30-day appendectomy rate, with a non-inferiority limit of 5%. Secondary endpoints were negative appendectomy rate, 30-day unplanned emergency department (ED) visits, and length of stay. Results: 30-day appendectomies were 16 (10.9%) in the outNOM group and 23 (14.6%) in the inNOM group (p = 0.327). OutNOM was non-inferior to inNOM with a risk difference of—3.80% 97.5% CI (− 12.57; 4.97). No difference was found between inNOM and outNOM groups for the number of complicated appendicitis (3 vs. 5) and negative appendectomy (1 vs. 0). Twenty-six (17.7%) outNOM patients required an unplanned ED visit after a median of 1 (1–4) days. In the outNOM group, the mean cumulative in-hospital stay was 0.89 (1.94) days compared with 3.94 (2.17) days in the inNOM group (p < 0.001). Conclusions: Outpatient NOM was non-inferior to inpatient NOM with regard to the 30-day appendectomy rate, while a shorter hospital stay was found in the outNOM group. Further, studies are required to confirm these findings. [ABSTRACT FROM AUTHOR]

Key Clinical Message: Actinomycosis is a rare cause of appendicitis with an incidence of 0.3–1 incident per year per 100,000 people. A significant preoperative diagnostic challenge exists and is usually diagnosed incidentally on histopathological examination. Appendicular actinomycosis, a rare, chronic granulomatous infection caused by actinomyces species, holds a significant preoperative diagnostic summons and is often diagnosed serendipitously during the regular histopathological examination. Herein, we present a case of a 36‐year‐old female who presented with features suggestive of acute appendicitis, underwent laparoscopic appendicectomy, and was diagnosed with appendicular actinomycosis from the histopathological examination. [ABSTRACT FROM AUTHOR]