BACKGROUND Acute appendicitis(AAp)is a prevalent medical condition characterized by inflammation of the appendix that frequently necessitates urgent surgical procedures.Approximately two-thirds of patients with AAp ex...BACKGROUND Acute appendicitis(AAp)is a prevalent medical condition characterized by inflammation of the appendix that frequently necessitates urgent surgical procedures.Approximately two-thirds of patients with AAp exhibit characteristic signs and symptoms;hence,negative AAp and complicated AAp are the primary concerns in research on AAp.In other terms,further investigations and algorithms are required for at least one third of patients to predict the clinical condition and distinguish them from uncomplicated patients with AAp.AIM To use a Stochastic Gradient Boosting(SGB)-based machine learning(ML)algorithm to tell the difference between AAp patients who are complicated and those who are not,and to find some important biomarkers for both types of AAp by using modeling to get variable importance values.METHODS This study analyzed an open access data set containing 140 people,including 41 healthy controls,65 individuals with uncomplicated AAp,and 34 individuals with complicated AAp.We analyzed some demographic data(age,sex)of the patients and the following biochemical blood parameters:White blood cell(WBC)count,neutrophils,lymphocytes,monocytes,platelet count,neutrophil-tolymphocyte ratio,lymphocyte-to-monocyte ratio,mean platelet volume,neutrophil-to-immature granulocyte ratio,ferritin,total bilirubin,immature granulocyte count,immature granulocyte percent,and neutrophil-to-immature granulocyte ratio.We tested the SGB model using n-fold cross-validation.It was implemented with an 80-20 training-test split.We used variable importance values to identify the variables that were most effective on the target.RESULTS The SGB model demonstrated excellent performance in distinguishing AAp from control patients with an accuracy of 96.3%,a micro aera under the curve(AUC)of 94.7%,a sensitivity of 94.7%,and a specificity of 100%.In distinguishing complicated AAp patients from uncomplicated ones,the model achieved an accuracy of 78.9%,a micro AUC of 79%,a sensitivity of 83.3%,and a specificity of 76.9%.The most useful biomarkers for confirming the AA diagnosis were WBC(100%),neutrophils(95.14%),and the lymphocyte-monocyte ratio(76.05%).On the other hand,the most useful biomarkers for accurate diagnosis of complicated AAp were total bilirubin(100%),WBC(96.90%),and the neutrophil-immature granulocytes ratio(64.05%).CONCLUSION The SGB model achieved high accuracy rates in identifying AAp patients while it showed moderate performance in distinguishing complicated AAp patients from uncomplicated AAp patients.Although the model's accuracy in the classification of complicated AAp is moderate,the high variable importance obtained is clinically significant.We need further prospective validation studies,but the integration of such ML algorithms into clinical practice may improve diagnostic processes.展开更多
Acute appendicitis(AAp)remains one of the most common abdominal emergencies,requiring rapid and accurate diagnosis to prevent complications and unnecessary surgeries.Conventional diagnostic methods,including medical h...Acute appendicitis(AAp)remains one of the most common abdominal emergencies,requiring rapid and accurate diagnosis to prevent complications and unnecessary surgeries.Conventional diagnostic methods,including medical history,clinical assessment,biochemical markers,and imaging techniques,often present limitations in sensitivity and specificity,especially in atypical cases.In recent years,artificial intelligence(AI)has demonstrated remarkable potential in enhancing diagnostic accuracy through machine learning(ML)and deep learning(DL)models.This review evaluates the current applications of AI in both adult and pediatric AAp,focusing on clinical data-based models,radiological imaging analysis,and AI-assisted clinical decision support systems.ML models such as random forest,support vector machines,logistic regression,and extreme gradient boosting have exhibited superior diagnostic performance compared to traditional scoring systems,achieving sensitivity and specificity rates exceeding 90%in multiple studies.Additionally,DL techniques,particularly convolutional neural networks,have been shown to outperform radiologists in interpreting ultrasound and computed tomography images,enhancing diagnostic confidence.This review synthesized findings from 65 studies,demonstrating that AI models integrating multimodal data including clinical,laboratory,and imaging parameters further improved diagnostic precision.Moreover,explainable AI approaches,such as SHapley Additive exPlanations and local interpretable model-agnostic explanations,have facilitated model transparency,fostering clinician trust in AI-driven decision-making.This review highlights the advancements in AI for AAp diagnosis,emphasizing that AI is used not only to establish the diagnosis of AAp but also to differentiate complicated from uncomplicated cases.While preliminary results are promising,further prospective,multicenter studies are required for large-scale clinical implementation,given that a great proportion of current evidence derives from retrospective designs,and existing prospective cohorts exhibit limited sample sizes or protocol variability.Future research should also focus on integrating AI-driven decision support tools into routine emergency care workflows.展开更多
BACKGROUND Acute appendicitis is common among pediatric patients,and postoperative infections and complications are significant factors that affect recovery.As a“forward-looking”nursing model,anticipatory care may r...BACKGROUND Acute appendicitis is common among pediatric patients,and postoperative infections and complications are significant factors that affect recovery.As a“forward-looking”nursing model,anticipatory care may reduce the incidence of postoperative wound infections and complications.AIM To explore the effects of anticipatory care on the management of postoperative infections and complications in pediatric patients diagnosed with acute appen-dicitis.METHODS This prospective randomized controlled study included data from 78 pediatric patients who underwent acute appendicitis surgery at Shijiazhuang Sixth Hos-pital(Hebei Province,China)between February 2021 and March 2024.Patients were divided into two groups:The intervention and control groups(n=39 each)were based on a random numbers table method.Both groups received routine postoperative nursing care,whereas the intervention group received additional anticipatory care.Statistical analyses were performed using independent sample t-tests,χ2 tests,analysis of variance,and rank-sum tests.RESULTS Postoperative pain scores and hospital length of stay were significantly lower in the intervention group than those in the control group(P<0.05 and P<0.001,respectively).Postoperative wound infection and overall complication rates were significantly lower in the intervention group than those in the control group(5.13%vs 23.08%,P<0.001;15.38%vs 46.15%,P<0.001,respectively).Furthermore,parental satisfaction scores were significantly higher in the intervention group than those in the control group(P<0.05).Logistic regression identified high C-reactive protein level as a risk factor for postoperative infections and complications,whereas proactive(i.e.anticipatory)nursing intervention was a protective factor.CONCLUSION This study provided a scientific basis for the implementation of anticipatory care in the postoperative management of pediatric patients experiencing acute appendicitis.展开更多
Appendicoliths are frequently encountered in acute appendicitis(AA)and historically considered a risk factor for treatment failure in nonoperative management(NOM).However,the impact of appendicoliths on recurrence rat...Appendicoliths are frequently encountered in acute appendicitis(AA)and historically considered a risk factor for treatment failure in nonoperative management(NOM).However,the impact of appendicoliths on recurrence rates in uncomplicated AA remains controversial.This editorial critically appraises the study by Kupietzky et al,which explored the relationship between appendicolith characteristics and NOM outcomes.Kupietzky et al conducted a retrospective analysis of 797 patients with uncomplicated AA,comparing recurrence rates between those with and without appendicoliths.The study focused on long-term follow-up(median 44.2 months)and subgroup analyses of stone characteristics.The study revealed no significant difference in overall recurrence rates between groups(26.5%vs 19.1%,P=0.14).However,patients with appendicoliths experienced earlier recurrence(3.9 months vs 5.9 months,P=0.04)and had larger appendix diameters(10.2 mm vs 8.5 mm,P=0.001).Subgroup analyses showed no correlation between stone size,location,or number and recurrence risk.Appendicoliths do not independently increase the overall recurrence risk after NOM for uncomplicated AA but may accelerate recurrence timelines.Clinical decisions should prioritize individualized risk assessment,considering patient age,symptom severity,and radiological features.These findings challenge traditional paradigms and advocate for shared decision-making between clinicians and patients.展开更多
BACKGROUND Acute appendicitis,a common condition with a higher prevalence among men,has shown an increasing incidence in recent years owing to lifestyle changes.It is characterized by right lower quadrant abdominal pa...BACKGROUND Acute appendicitis,a common condition with a higher prevalence among men,has shown an increasing incidence in recent years owing to lifestyle changes.It is characterized by right lower quadrant abdominal pain,rebound tenderness,and rapid onset.Its pathogenesis is complex and potentially linked to infection,environment,and genetics.Timely intervention is crucial to prevent complications.While surgery is the primary treatment,it carries risks,including postoperative infections that may necessitate re-operation.Gram-negative bacteria release endotoxin(ETX),which induces inflammation and is recognized by toll-like receptor 4(TLR4).This study evaluated ETX and TLR4 levels in patients with acute appendicitis to assess the risk of postoperative incision infections,aiding in prevention and treatment.AIM To explore ETX and TLR4 expression in the blood of patients with acute appendicitis and its association with in postoperative incision infection.METHODS A total of 153 patients with acute appendicitis treated at our hospital between April 2022 and March 2024(n=153)were included in the study.Patients were categorized into infected(n=36)and uninfected(n=117)groups according to the development of postoperative incision infections.General characteristics and blood levels of ETX and TLR4 were compared,and the factors influencing postoperative infection were identified using multivariate logistic regression.ETX and TLR4 predictive values were analyzed using receiver operating characteristic curves.RESULTS No statistically significant differences were observed between the two groups in terms of sex,age,or other general characteristics(P>0.05).Compared to the uninfected group,the infected group had a higher proportion of patients with suppurative or gangrenous appendicitis,longer surgical times,longer incision lengths,and elevated ETX and TLR4 levels(P<0.05).Multivariate logistic regression analysis identified pathological type,surgical method,surgical time,and incision length as factors influencing postoperative incision infection in acute appendicitis.Receiver operating characteristic curve analysis revealed that both ETX and TLR4 levels were predictive factors for postoperative incision infection,with higher prediction efficiency when combined.CONCLUSION Pathological type,surgical method,surgical time,and incision length significantly influence postoperative incision infection risk in patients with acute appendicitis.Elevated ETX and TLR4 levels serve as valuable predictors of post-appendectomy infections.展开更多
In the present study,data mining and network pharmacology were utilized to explore the principles and mechanisms of traditional Chinese medicine(TCM)in treating acute appendicitis.The goal was to provide a scientific ...In the present study,data mining and network pharmacology were utilized to explore the principles and mechanisms of traditional Chinese medicine(TCM)in treating acute appendicitis.The goal was to provide a scientific basis for clinical treatment and further research on this disease.First,we searched the National Patent Database for Chinese herbal compound prescriptions used to treat acute appendicitis.We then applied frequency analysis,character and taste meridian analysis,association rule analysis,and hierarchical cluster analysis to identify the patterns of TCM treatment for acute appendicitis,selecting key combinations of Chinese medicines.Next,we screened the main active components of these key TCM based on quality markers.Using databases such as SwissTargetPrediction,SymMap,ETCM,and STRING,we analyzed the pharmacological mechanisms of these key TCM in treating acute appendicitis.Key active components and targets were further verified through molecular docking.We identified a total of 129 patents involving 316 Chinese medicines,with 24 being frequently used.The results indicated that most Chinese herbs used for acute appendicitis were heat-clearing drugs,blood-activating and stasis-removing drugs,and purging drugs.The primary active ingredients of the Rhubarb-cortex moutan-flos lonicerae combination for treating acute appendicitis included Emodin,Paeonol,Physcion,Chlorogenic acid,Chrysophanol,Rhein acid,and Aloe-emodin.These ingredients targeted key proteins such as ALB,TP53,BCL2,STAT3,IL-6,and TNF,and were involved in cellular responses to lipopolysaccharides,cell composition,and various cytokine-mediated biological processes.They also interacted with signaling pathways like AGE-RAGE,TNF,IL-17,and FoxO.Based on patent data,this study analyzed medication patterns in the treatment of acute appendicitis,discussed the possible mechanisms of key TCM combinations,and provided a scientific basis and new perspectives for the diagnosis and treatment of the disease.展开更多
BACKGROUND Laparoscopic surgery has emerged as the preferred treatment for acute appendicitis,a common acute abdominal condition.Despite surgical advances,postoperative gastrointestinal dysfunction and delayed recover...BACKGROUND Laparoscopic surgery has emerged as the preferred treatment for acute appendicitis,a common acute abdominal condition.Despite surgical advances,postoperative gastrointestinal dysfunction and delayed recovery continue to negatively impact rehabilitation outcomes and patient quality of life.Laser acupuncture represents a promising emerging complementary therapy with potential benefits for promoting functional recovery.AIM To evaluate the clinical efficacy of laser acupuncture in enhancing gastrointestinal function recovery following laparoscopic appendectomy and to investigate its potential applications in postoperative rehabilitation.METHODS This retrospective controlled clinical study selected 120 acute appendicitis patients who underwent laparoscopic appendectomy from January 2022 to December 2023 at a tertiary hospital.Patients were randomly divided into two groups:Routine treatment group(n=60)and laser acupuncture intervention group(n=60).There were no significant statistical differences in baseline characteristics(age,gender,body mass index,appendicitis severity)between the two groups.The routine treatment group received standard postoperative care,while the laser acupuncture intervention group received additional laser acupuncture treatment on top of standard care.Key observation indicators included time to first exhaust,time to first bowel movement,time to gastrointestinal function recovery,and postoperative complication rates.RESULTS Patients in the laser acupuncture intervention group showed significantly faster gastrointestinal function recovery compared to the routine treatment group.Specifically,time to first exhaust was significantly shortened(intervention group:12.5±2.3 hours vs control group:18.7±3.1 hours,P<0.05),time to first bowel movement was earlier(intervention group:36.4±4.6 hours vs control group:48.2±5.7 hours,P<0.05),postoperative complication rate was significantly reduced(intervention group:8.3%vs control group:20.0%,P<0.05),postoperative pain score was significantly lower(intervention group:3.2±1.1 vs control group:4.7±1.5,P<0.05),and intestinal motility recovery was faster and more effective.CONCLUSION Laser acupuncture,as an auxiliary treatment method,can significantly promote gastrointestinal function recovery in patients after laparoscopic appendectomy,reduce complications,and improve postoperative comfort.This technique has advantages such as minimal invasiveness,rapid recovery,and few side effects,making it worthy of further clinical promotion and application.展开更多
BACKGROUND Acute appendicitis(AP)is a frequently encountered surgical emergency,and appendectomy is conventionally regarded as the predominant treatment moda-lity.Nevertheless,the therapeutic efficacy of this surgical...BACKGROUND Acute appendicitis(AP)is a frequently encountered surgical emergency,and appendectomy is conventionally regarded as the predominant treatment moda-lity.Nevertheless,the therapeutic efficacy of this surgical approach remains to be improved.Thus,the exploration and implementation of surgical refinements are necessary.AIM To elucidate the therapeutic effectiveness and influencing factors of laparoscopic appendectomy(LA)with mesoappendix dissection in the treatment of AP.METHODS First,150 patients with AP who visited Shangrao Municipal Hospital between January 2022 and June 2024 were enrolled in this study.Among them,72 patients were assigned to the control group to receive conventional LA,whereas 78 cases were included in the observation group for LA with mesoappendix dissection.Subsequently,indicators such as therapeutic effectiveness,surgical indices(ope-ration time,intraoperative blood loss,and hospital stay),postoperative recovery indices(time to ambulation,gastrointestinal function recovery time,and time to food intake),incidence of adverse events(postoperative bleeding,pelvic infection,puncture site infection,and ileus),and serum inflammatory factors[tumor necro-sis factor(TNF)-α,interleukin(IL)-6,and C-reactive protein(CRP)]were collected and comparatively analyzed,and the influencing factors of therapeutic effecti-veness in patients with AP were analyzed.RESULTS Compared with the control group,the observation group had higher clinical the-rapeutic effectiveness,less operation time,intraoperative blood loss,and hospital stay;shorter time to ambulation,gastrointestinal function recovery,and food intake;and a lower total incidence of adverse events,and this difference is statistically significant.In addition,the expression levels of various serum inflammatory factors in the observation group were significantly reduced postoperatively,which were markedly lower than those in the control group.Moreover,sex,age,body mass index,time from acute onset to admission,family medical history,preoperative TNF-α,preoperative IL-6,preoperative CRP,and treatment modality were identified to be not independent factors affecting the therapeutic effectiveness of LA with mesoappendix dissection in patients with AP.CONCLUSION Overall,LA with mesoappendix dissection has a remarkable curative effect in treating patients with AP,which is worthy of clinical promotion.展开更多
Objective:To investigate the diagnostic value of multi-slice spiral CT(MSCT)for patients with acute appendicitis(AA).Methods:Fifty patients with suspected AA who visited the hospital from January 2023 to January 2025 ...Objective:To investigate the diagnostic value of multi-slice spiral CT(MSCT)for patients with acute appendicitis(AA).Methods:Fifty patients with suspected AA who visited the hospital from January 2023 to January 2025 were selected as samples.All patients underwent MSCT and ultrasound diagnosis,and the diagnostic efficacy of MSCT was analyzed in comparison with pathology.Results:Pathology indicated 40 positive and 10 negative cases,ultrasound indicated 30 positive and 20 negative cases,and MSCT indicated 39 positive and 11 negative cases.The diagnostic efficacy of MSCT was higher than that of ultrasound(P<0.05).The accuracy of pathological classification of MSCT was higher than that of ultrasound(P<0.05).The detection rate of MSCT imaging indicators in AA patients was higher than that in non-AA patients(P<0.05).Conclusion:MSCT has high diagnostic efficacy in AA patients and can assist physicians in determining pathological classification.展开更多
Acute appendicitis is a common surgical emergency.It is commonly caused by obstruction of the appendiceal lumen due to fecaliths,tumors,or lymphoid hyperplasia.For over a century,appendectomy has been the primary trea...Acute appendicitis is a common surgical emergency.It is commonly caused by obstruction of the appendiceal lumen due to fecaliths,tumors,or lymphoid hyperplasia.For over a century,appendectomy has been the primary treatment for acute appendicitis.Abraham Groves performed the first open appendectomy in 1883.In 1983,Kurt Semm completed the first laparoscopic appendectomy,heralding a new era in appendectomy.However,appendectomy is associated with certain complications and a rate of negative appendectomies.Studies have suggested controversy over the impact of appendectomy on the development of inflammatory bowel disease and Parkinson’s disease,but an increasing number of studies indicate a possible positive correlation between appendectomy and colorectal cancer,gallstones,and cardiovascular disease.With the recognition that the appendix is not a vestigial organ and the advancement of endoscopic technology,Liu proposed the endoscopic retrograde appendicitis therapy.It is an effective minimally invasive alternative for treating uncomplicated acute appendicitis.Our team has developed an appendoscope with a disposable digital imaging system operated through the biopsy channel of a colonoscope and successfully applied it in the treatment of appendicitis.This article provides an overview of the progress in endoscopic treatment for acute appendicitis and offers a new perspective on the future direction of appendiceal disease treatment.展开更多
BACKGROUND The maximum outer diameter(MOD)of the appendix is an essential parameter for diagnosing acute appendicitis,but there is space for improvement in ultrasound(US)diagnostic performance.AIM To investigate wheth...BACKGROUND The maximum outer diameter(MOD)of the appendix is an essential parameter for diagnosing acute appendicitis,but there is space for improvement in ultrasound(US)diagnostic performance.AIM To investigate whether combining the ratio of the cross diameters(RATIO)of the appendix with MOD of the appendix can enhance the diagnostic performance of acute appendicitis.METHODS A retrospective study was conducted,and medical records of 233 patients with acute appendicitis and 112 patients with a normal appendix were reviewed.The MOD and RATIO of the appendix were calculated and tested for their diagnostic performance of acute appendicitis,both individually and in combination.RESULTS The RATIO for a normal appendix was 1.32±0.16,while for acute appendicitis it was 1.09±0.07.The cut-off value for RATIO was determined to be≤1.18.The area under the receiver operating characteristic curve(AUC)for diagnosing acute appendicitis using RATIO≤1.18 and MOD>6 mm was 0.870 and 0.652,respectively.There was a significant difference in AUC between RATIO≤1.18 and MOD>6 mm(P<0.0001).When comparing the combination of RATIO≤1.18 and MOD>6 mm with MOD>6 mm alone,the combination showed increased specificity,positive predictive value(PPV),and AUC.However,the sensitivity and negative predictive value decreased.CONCLUSION Combining RATIO of the appendix≤1.18 and MOD>6 mm can significantly improve the specificity,PPV,and AUC in the US diagnosis of acute appendicitis.展开更多
In developed countries,the average life expectancy has been increasing and is now well over 80 years.Increased life expectancy is associated with an increased number of emergency surgical procedures performed in later...In developed countries,the average life expectancy has been increasing and is now well over 80 years.Increased life expectancy is associated with an increased number of emergency surgical procedures performed in later age groups.Acute appendicitis is one of the most common surgical diseases,with a lifetime risk of 8%.A growing incidence of acute appendicitis has been registered in the elderly population and in the oldest groups(>80 years).Among patients>50-year-old who present to the emergency department for acute abdominal pain,15%have acute appendicitis.In these patients,emergency surgery for acute appendicitis is challenging,and some important aspects must be considered.In the elderly,surgical treatment outcomes are influenced by sarcopenia.Sarcopenia must be considered a precursor of frailty,a risk factor for physical function decline.Sarcopenia has a negative impact on both elective and emergency surgery regarding mortality and morbidity.Aside from morbidity and mortality,the most crucial outcomes for older patients requiring emergency surgery are reduction in function decline and preoperative physical function maintenance.Therefore,prediction of function decline is critical.In emergency surgery,preoperative interventions are difficult to implement because of the narrow time window before surgery.In this editorial,we highlight the unique aspects of acute appendicitis in elderly patients and the influence of sarcopenia and frailty on the results of surgical treatment.展开更多
BACKGROUND Acute appendicitis is one of the most common emergency abdominal disease,and recent studies have evaluated conservative treatment using antibiotics for uncomplicated appendicitis.Although the efficacy of co...BACKGROUND Acute appendicitis is one of the most common emergency abdominal disease,and recent studies have evaluated conservative treatment using antibiotics for uncomplicated appendicitis.Although the efficacy of conservative treatment for uncomplicated appendicitis is known,its efficacy for complicated appendicitis remains unknown,so are risk factors for the conservative treatment of appendi-citis.In our institution,conservative treatment has long been the first choice for most appendicitis cases,except for perforation.Therefore,this novel study inves-tigated the outcomes of conservative treatment for uncomplicated and compli-cated acute appendicitis and the risk factors associated with conservative treat-ment.treatment.The significant and independent predictors of resistance to conservative treatment were body temperature≥37.3℃,appendicolith and Douglas sinus fluid visible on computed tomography(CT).The rate of resistance to conservative treatment was 66.7%(6/9)for patients with the above three factors,22.9%(8/35)for patients with two factors(appendicolith and body temperature≥37.3℃),16.7%(2/12)for patients with two factors(Douglas sinus fluid and appendicolith)and 11.1%(1/9)for patients with two factors(Douglas sinus fluid and body temperature≥37.3℃).CONCLUSION A temperature≥37.3℃,appendicolith and Douglas sinus fluid on CT might be clinical risk factors of resistance to conservative treatment for acute appendicitis.展开更多
BACKGROUND Acute appendicitis(AA)is the most common cause of acute abdomen in children.Anesthesia significantly influences the surgical treatment of AA in children,making the scientific and effective selection of anes...BACKGROUND Acute appendicitis(AA)is the most common cause of acute abdomen in children.Anesthesia significantly influences the surgical treatment of AA in children,making the scientific and effective selection of anesthetics crucial.AIM To assess the clinical effect of atropine(ATR)in combination with remifentanil(REMI)in children undergoing surgery for AA.METHODS In total,108 cases of pediatric AA treated between May 2020 and May 2023 were selected,58 of which received ATR+REMI[research group(RG)]and 50 who received REMI[control group(CG)].Comparative analyses were conducted on the time to loss of eyelash reflex,pain resolution time,recovery time from anesthesia,incidence of adverse events(AEs;respiratory depression,hypoxemia,bradycardia,nausea and vomiting,and hypotension),intraoperative responses(head shaking,limb activity,orientation recovery,safe departure time from the operating room),hemodynamic parameters[oxygen saturation(SPO2),mean arterial pressure,heart rate,and respiratory rate],postoperative sedation score(Ramsay score),and pain level[the Face,Legs,Activity,Cry,Consolability(FLACC)Behavioral Scale].RESULTS Compared with the CG,the RG showed significantly shorter time to loss of eyelash reflex,pain resolution,recovery from anesthesia,and safe departure from the operating room.Furthermore,the incidence rates of overall AEs(head shaking,limb activity,etc.)were lower,and influences on intraoperative hemodynamic parameters and stress response indexes were fewer.The Ramsay score at 30 min after extubation and the FLACC score at 60 min after extubation were significantly lower in the RG than in the CG.CONCLUSION ATR+REMI is superior to REMI alone in children undergoing AA surgery,with a lower incidence of AEs,fewer influences on hemodynamics and stress responses,and better post-anesthesia recovery.展开更多
Acute appendicitis(AA) develops in a progressive and irreversible manner, even if the clinical course of AA can be temporarily modified by intentional medications. Reliable and real-time diagnosis of AA can be made ba...Acute appendicitis(AA) develops in a progressive and irreversible manner, even if the clinical course of AA can be temporarily modified by intentional medications. Reliable and real-time diagnosis of AA can be made based on findings of the white blood cell count and enhanced computed tomography. Emergent laparoscopic appendectomy(LA) is considered as the first therapeutic choice for AA. Interval/delayed appendectomy at 6-12 wk after disease onset is considered as unsafe with a high recurrent rate during the waiting time. However, this technique may have some advantages for avoiding unnecessary extended resection in patients with an appendiceal mass. Nonoperative management of AA may be tolerated only in children. Postoperative complications increase according to the patient's factors, and temporal avoidance of emergent general anesthesia may be beneficial for high-risk patients. The surgeon's skill and cooperation of the hospital are important for successful LA. Delaying appendectomy for less than 24 h from diagnosis is safe. Additionally, a semi-elective manner(i.e., LA within 24 h after onset of symptoms) may be paradoxically acceptable, according to the factors of the patient, physician, and institution. Prompt LA is mandatory for AA. Fortunately, the Japanese government uses a universal health insurance system, which covers LA.展开更多
Pylephlebitis, a rare complication of acute appendicitis, is defined as thrombophlebitis of the portal venous system. Pylephlebitis usually occurs due to secondary infection in the region drained into the portal syste...Pylephlebitis, a rare complication of acute appendicitis, is defined as thrombophlebitis of the portal venous system. Pylephlebitis usually occurs due to secondary infection in the region drained into the portal system. We report a case of pylephlebitis caused by acute appendicitis. The patient was transferred from a private clinic 1 wk after appendectomy with the chief complaints of high fever and abdominal pain. He was diagnosed with pylephlebitis of the portal vein and superior mesenteric vein by CT-scan. The patient was treated with antibiotics and anticoagulation therapy, and discharged on the 25th day and follow-up CT scan showed a cavernous transformation of portal thrombosis.展开更多
BACKGROUND Appendectomy is the procedure of choice for the treatment of acute appendicitis.However,surgery may not be appropriate for patients with coexisting severe illness or comorbidities such as acute pancreatitis...BACKGROUND Appendectomy is the procedure of choice for the treatment of acute appendicitis.However,surgery may not be appropriate for patients with coexisting severe illness or comorbidities such as acute pancreatitis(AP).Endoscopic retrograde appendicitis treatment(ERAT)may be a novel alternative to surgery for treating such patients where existing medical therapies have failed.CASE SUMMARY We report 2 cases of moderately severe AP who developed acute uncomplicated appendicitis during their hospital stay and did not respond to traditional medical therapy.One patient had moderately severe AP due to hyperlipidemia,while the other patient had a gallstone induced by moderately severe AP.Neither patient was fit to undergo an appendectomy procedure because of the concurrent AP.Therefore,the alternative and minimally invasive ERAT was considered.After written informed consent was collected from the patients,the ERAT procedure was performed.Both patients exhibited fast postoperative recovery after ERAT with minimal surgical trauma.CONCLUSION ERAT is a safe and effective minimally invasive endoscopic procedure for acute appendicitis in patients with coexistent AP.展开更多
Acute appendicitis(AA)is the most common acute abdomen,and appendectomy is the most common nonelective surgery performed worldwide.Despite the long history of understanding this disease and enhancements to medical car...Acute appendicitis(AA)is the most common acute abdomen,and appendectomy is the most common nonelective surgery performed worldwide.Despite the long history of understanding this disease and enhancements to medical care,many challenges remain in the diagnosis and treatment of AA.One of these challenges is the timing of appendectomy.In recent decades,extensive studies focused on this topic have been conducted,but there have been no conclusive answers.From the onset of symptoms to appendectomy,many factors can cause delay in the surgical intervention.Some are inevitable,and some can be modified and improved.The favorable and unfavorable results of these factors vary according to different situations.The purpose of this review is to discuss the causes of appendectomy delay and its risk-related costs.This review also explores strategies to balance the positive and negative effects of delayed appendectomy.展开更多
BACKGROUND Acute appendicitis with mesenteric vein thrombosis(MVT)is an uncommon condition and usually lacks specific clinical manifestations,which leads to a high rate of misdiagnosis or delayed diagnosis,especially ...BACKGROUND Acute appendicitis with mesenteric vein thrombosis(MVT)is an uncommon condition and usually lacks specific clinical manifestations,which leads to a high rate of misdiagnosis or delayed diagnosis,especially when it is accompanied by other abdominal diseases.Prompt and accurate recognition is vital for treatment and prognosis.CASE SUMMARY A 37-year-old woman had a history of acute metastatic right lower abdominal pain,nausea,and fever.A contrast-enhanced computed tomography(CT)scan showed a filling defect in the mesenteric vessels.The patient was diagnosed with acute appendicitis complicated by MVT and was treated with anticoagulation and intravenous antibiotics.The follow-up CT scan showed full resolution of the thrombosis and inflammation.CONCLUSION Clinical awareness is essential for recognizing MVT,especially when it is accompanied by other common acute abdominal diseases,such as acute appendicitis.Contrast-enhanced CT is helpful for the diagnosis of MVT and is recommended for patients with acute abdominal diseases.展开更多
文摘BACKGROUND Acute appendicitis(AAp)is a prevalent medical condition characterized by inflammation of the appendix that frequently necessitates urgent surgical procedures.Approximately two-thirds of patients with AAp exhibit characteristic signs and symptoms;hence,negative AAp and complicated AAp are the primary concerns in research on AAp.In other terms,further investigations and algorithms are required for at least one third of patients to predict the clinical condition and distinguish them from uncomplicated patients with AAp.AIM To use a Stochastic Gradient Boosting(SGB)-based machine learning(ML)algorithm to tell the difference between AAp patients who are complicated and those who are not,and to find some important biomarkers for both types of AAp by using modeling to get variable importance values.METHODS This study analyzed an open access data set containing 140 people,including 41 healthy controls,65 individuals with uncomplicated AAp,and 34 individuals with complicated AAp.We analyzed some demographic data(age,sex)of the patients and the following biochemical blood parameters:White blood cell(WBC)count,neutrophils,lymphocytes,monocytes,platelet count,neutrophil-tolymphocyte ratio,lymphocyte-to-monocyte ratio,mean platelet volume,neutrophil-to-immature granulocyte ratio,ferritin,total bilirubin,immature granulocyte count,immature granulocyte percent,and neutrophil-to-immature granulocyte ratio.We tested the SGB model using n-fold cross-validation.It was implemented with an 80-20 training-test split.We used variable importance values to identify the variables that were most effective on the target.RESULTS The SGB model demonstrated excellent performance in distinguishing AAp from control patients with an accuracy of 96.3%,a micro aera under the curve(AUC)of 94.7%,a sensitivity of 94.7%,and a specificity of 100%.In distinguishing complicated AAp patients from uncomplicated ones,the model achieved an accuracy of 78.9%,a micro AUC of 79%,a sensitivity of 83.3%,and a specificity of 76.9%.The most useful biomarkers for confirming the AA diagnosis were WBC(100%),neutrophils(95.14%),and the lymphocyte-monocyte ratio(76.05%).On the other hand,the most useful biomarkers for accurate diagnosis of complicated AAp were total bilirubin(100%),WBC(96.90%),and the neutrophil-immature granulocytes ratio(64.05%).CONCLUSION The SGB model achieved high accuracy rates in identifying AAp patients while it showed moderate performance in distinguishing complicated AAp patients from uncomplicated AAp patients.Although the model's accuracy in the classification of complicated AAp is moderate,the high variable importance obtained is clinically significant.We need further prospective validation studies,but the integration of such ML algorithms into clinical practice may improve diagnostic processes.
文摘Acute appendicitis(AAp)remains one of the most common abdominal emergencies,requiring rapid and accurate diagnosis to prevent complications and unnecessary surgeries.Conventional diagnostic methods,including medical history,clinical assessment,biochemical markers,and imaging techniques,often present limitations in sensitivity and specificity,especially in atypical cases.In recent years,artificial intelligence(AI)has demonstrated remarkable potential in enhancing diagnostic accuracy through machine learning(ML)and deep learning(DL)models.This review evaluates the current applications of AI in both adult and pediatric AAp,focusing on clinical data-based models,radiological imaging analysis,and AI-assisted clinical decision support systems.ML models such as random forest,support vector machines,logistic regression,and extreme gradient boosting have exhibited superior diagnostic performance compared to traditional scoring systems,achieving sensitivity and specificity rates exceeding 90%in multiple studies.Additionally,DL techniques,particularly convolutional neural networks,have been shown to outperform radiologists in interpreting ultrasound and computed tomography images,enhancing diagnostic confidence.This review synthesized findings from 65 studies,demonstrating that AI models integrating multimodal data including clinical,laboratory,and imaging parameters further improved diagnostic precision.Moreover,explainable AI approaches,such as SHapley Additive exPlanations and local interpretable model-agnostic explanations,have facilitated model transparency,fostering clinician trust in AI-driven decision-making.This review highlights the advancements in AI for AAp diagnosis,emphasizing that AI is used not only to establish the diagnosis of AAp but also to differentiate complicated from uncomplicated cases.While preliminary results are promising,further prospective,multicenter studies are required for large-scale clinical implementation,given that a great proportion of current evidence derives from retrospective designs,and existing prospective cohorts exhibit limited sample sizes or protocol variability.Future research should also focus on integrating AI-driven decision support tools into routine emergency care workflows.
文摘BACKGROUND Acute appendicitis is common among pediatric patients,and postoperative infections and complications are significant factors that affect recovery.As a“forward-looking”nursing model,anticipatory care may reduce the incidence of postoperative wound infections and complications.AIM To explore the effects of anticipatory care on the management of postoperative infections and complications in pediatric patients diagnosed with acute appen-dicitis.METHODS This prospective randomized controlled study included data from 78 pediatric patients who underwent acute appendicitis surgery at Shijiazhuang Sixth Hos-pital(Hebei Province,China)between February 2021 and March 2024.Patients were divided into two groups:The intervention and control groups(n=39 each)were based on a random numbers table method.Both groups received routine postoperative nursing care,whereas the intervention group received additional anticipatory care.Statistical analyses were performed using independent sample t-tests,χ2 tests,analysis of variance,and rank-sum tests.RESULTS Postoperative pain scores and hospital length of stay were significantly lower in the intervention group than those in the control group(P<0.05 and P<0.001,respectively).Postoperative wound infection and overall complication rates were significantly lower in the intervention group than those in the control group(5.13%vs 23.08%,P<0.001;15.38%vs 46.15%,P<0.001,respectively).Furthermore,parental satisfaction scores were significantly higher in the intervention group than those in the control group(P<0.05).Logistic regression identified high C-reactive protein level as a risk factor for postoperative infections and complications,whereas proactive(i.e.anticipatory)nursing intervention was a protective factor.CONCLUSION This study provided a scientific basis for the implementation of anticipatory care in the postoperative management of pediatric patients experiencing acute appendicitis.
文摘Appendicoliths are frequently encountered in acute appendicitis(AA)and historically considered a risk factor for treatment failure in nonoperative management(NOM).However,the impact of appendicoliths on recurrence rates in uncomplicated AA remains controversial.This editorial critically appraises the study by Kupietzky et al,which explored the relationship between appendicolith characteristics and NOM outcomes.Kupietzky et al conducted a retrospective analysis of 797 patients with uncomplicated AA,comparing recurrence rates between those with and without appendicoliths.The study focused on long-term follow-up(median 44.2 months)and subgroup analyses of stone characteristics.The study revealed no significant difference in overall recurrence rates between groups(26.5%vs 19.1%,P=0.14).However,patients with appendicoliths experienced earlier recurrence(3.9 months vs 5.9 months,P=0.04)and had larger appendix diameters(10.2 mm vs 8.5 mm,P=0.001).Subgroup analyses showed no correlation between stone size,location,or number and recurrence risk.Appendicoliths do not independently increase the overall recurrence risk after NOM for uncomplicated AA but may accelerate recurrence timelines.Clinical decisions should prioritize individualized risk assessment,considering patient age,symptom severity,and radiological features.These findings challenge traditional paradigms and advocate for shared decision-making between clinicians and patients.
文摘BACKGROUND Acute appendicitis,a common condition with a higher prevalence among men,has shown an increasing incidence in recent years owing to lifestyle changes.It is characterized by right lower quadrant abdominal pain,rebound tenderness,and rapid onset.Its pathogenesis is complex and potentially linked to infection,environment,and genetics.Timely intervention is crucial to prevent complications.While surgery is the primary treatment,it carries risks,including postoperative infections that may necessitate re-operation.Gram-negative bacteria release endotoxin(ETX),which induces inflammation and is recognized by toll-like receptor 4(TLR4).This study evaluated ETX and TLR4 levels in patients with acute appendicitis to assess the risk of postoperative incision infections,aiding in prevention and treatment.AIM To explore ETX and TLR4 expression in the blood of patients with acute appendicitis and its association with in postoperative incision infection.METHODS A total of 153 patients with acute appendicitis treated at our hospital between April 2022 and March 2024(n=153)were included in the study.Patients were categorized into infected(n=36)and uninfected(n=117)groups according to the development of postoperative incision infections.General characteristics and blood levels of ETX and TLR4 were compared,and the factors influencing postoperative infection were identified using multivariate logistic regression.ETX and TLR4 predictive values were analyzed using receiver operating characteristic curves.RESULTS No statistically significant differences were observed between the two groups in terms of sex,age,or other general characteristics(P>0.05).Compared to the uninfected group,the infected group had a higher proportion of patients with suppurative or gangrenous appendicitis,longer surgical times,longer incision lengths,and elevated ETX and TLR4 levels(P<0.05).Multivariate logistic regression analysis identified pathological type,surgical method,surgical time,and incision length as factors influencing postoperative incision infection in acute appendicitis.Receiver operating characteristic curve analysis revealed that both ETX and TLR4 levels were predictive factors for postoperative incision infection,with higher prediction efficiency when combined.CONCLUSION Pathological type,surgical method,surgical time,and incision length significantly influence postoperative incision infection risk in patients with acute appendicitis.Elevated ETX and TLR4 levels serve as valuable predictors of post-appendectomy infections.
基金Henan Province Special Research Project of Tra ditional Chinese Medicine(Grant No.2022ZY1090).
文摘In the present study,data mining and network pharmacology were utilized to explore the principles and mechanisms of traditional Chinese medicine(TCM)in treating acute appendicitis.The goal was to provide a scientific basis for clinical treatment and further research on this disease.First,we searched the National Patent Database for Chinese herbal compound prescriptions used to treat acute appendicitis.We then applied frequency analysis,character and taste meridian analysis,association rule analysis,and hierarchical cluster analysis to identify the patterns of TCM treatment for acute appendicitis,selecting key combinations of Chinese medicines.Next,we screened the main active components of these key TCM based on quality markers.Using databases such as SwissTargetPrediction,SymMap,ETCM,and STRING,we analyzed the pharmacological mechanisms of these key TCM in treating acute appendicitis.Key active components and targets were further verified through molecular docking.We identified a total of 129 patents involving 316 Chinese medicines,with 24 being frequently used.The results indicated that most Chinese herbs used for acute appendicitis were heat-clearing drugs,blood-activating and stasis-removing drugs,and purging drugs.The primary active ingredients of the Rhubarb-cortex moutan-flos lonicerae combination for treating acute appendicitis included Emodin,Paeonol,Physcion,Chlorogenic acid,Chrysophanol,Rhein acid,and Aloe-emodin.These ingredients targeted key proteins such as ALB,TP53,BCL2,STAT3,IL-6,and TNF,and were involved in cellular responses to lipopolysaccharides,cell composition,and various cytokine-mediated biological processes.They also interacted with signaling pathways like AGE-RAGE,TNF,IL-17,and FoxO.Based on patent data,this study analyzed medication patterns in the treatment of acute appendicitis,discussed the possible mechanisms of key TCM combinations,and provided a scientific basis and new perspectives for the diagnosis and treatment of the disease.
文摘BACKGROUND Laparoscopic surgery has emerged as the preferred treatment for acute appendicitis,a common acute abdominal condition.Despite surgical advances,postoperative gastrointestinal dysfunction and delayed recovery continue to negatively impact rehabilitation outcomes and patient quality of life.Laser acupuncture represents a promising emerging complementary therapy with potential benefits for promoting functional recovery.AIM To evaluate the clinical efficacy of laser acupuncture in enhancing gastrointestinal function recovery following laparoscopic appendectomy and to investigate its potential applications in postoperative rehabilitation.METHODS This retrospective controlled clinical study selected 120 acute appendicitis patients who underwent laparoscopic appendectomy from January 2022 to December 2023 at a tertiary hospital.Patients were randomly divided into two groups:Routine treatment group(n=60)and laser acupuncture intervention group(n=60).There were no significant statistical differences in baseline characteristics(age,gender,body mass index,appendicitis severity)between the two groups.The routine treatment group received standard postoperative care,while the laser acupuncture intervention group received additional laser acupuncture treatment on top of standard care.Key observation indicators included time to first exhaust,time to first bowel movement,time to gastrointestinal function recovery,and postoperative complication rates.RESULTS Patients in the laser acupuncture intervention group showed significantly faster gastrointestinal function recovery compared to the routine treatment group.Specifically,time to first exhaust was significantly shortened(intervention group:12.5±2.3 hours vs control group:18.7±3.1 hours,P<0.05),time to first bowel movement was earlier(intervention group:36.4±4.6 hours vs control group:48.2±5.7 hours,P<0.05),postoperative complication rate was significantly reduced(intervention group:8.3%vs control group:20.0%,P<0.05),postoperative pain score was significantly lower(intervention group:3.2±1.1 vs control group:4.7±1.5,P<0.05),and intestinal motility recovery was faster and more effective.CONCLUSION Laser acupuncture,as an auxiliary treatment method,can significantly promote gastrointestinal function recovery in patients after laparoscopic appendectomy,reduce complications,and improve postoperative comfort.This technique has advantages such as minimal invasiveness,rapid recovery,and few side effects,making it worthy of further clinical promotion and application.
文摘BACKGROUND Acute appendicitis(AP)is a frequently encountered surgical emergency,and appendectomy is conventionally regarded as the predominant treatment moda-lity.Nevertheless,the therapeutic efficacy of this surgical approach remains to be improved.Thus,the exploration and implementation of surgical refinements are necessary.AIM To elucidate the therapeutic effectiveness and influencing factors of laparoscopic appendectomy(LA)with mesoappendix dissection in the treatment of AP.METHODS First,150 patients with AP who visited Shangrao Municipal Hospital between January 2022 and June 2024 were enrolled in this study.Among them,72 patients were assigned to the control group to receive conventional LA,whereas 78 cases were included in the observation group for LA with mesoappendix dissection.Subsequently,indicators such as therapeutic effectiveness,surgical indices(ope-ration time,intraoperative blood loss,and hospital stay),postoperative recovery indices(time to ambulation,gastrointestinal function recovery time,and time to food intake),incidence of adverse events(postoperative bleeding,pelvic infection,puncture site infection,and ileus),and serum inflammatory factors[tumor necro-sis factor(TNF)-α,interleukin(IL)-6,and C-reactive protein(CRP)]were collected and comparatively analyzed,and the influencing factors of therapeutic effecti-veness in patients with AP were analyzed.RESULTS Compared with the control group,the observation group had higher clinical the-rapeutic effectiveness,less operation time,intraoperative blood loss,and hospital stay;shorter time to ambulation,gastrointestinal function recovery,and food intake;and a lower total incidence of adverse events,and this difference is statistically significant.In addition,the expression levels of various serum inflammatory factors in the observation group were significantly reduced postoperatively,which were markedly lower than those in the control group.Moreover,sex,age,body mass index,time from acute onset to admission,family medical history,preoperative TNF-α,preoperative IL-6,preoperative CRP,and treatment modality were identified to be not independent factors affecting the therapeutic effectiveness of LA with mesoappendix dissection in patients with AP.CONCLUSION Overall,LA with mesoappendix dissection has a remarkable curative effect in treating patients with AP,which is worthy of clinical promotion.
文摘Objective:To investigate the diagnostic value of multi-slice spiral CT(MSCT)for patients with acute appendicitis(AA).Methods:Fifty patients with suspected AA who visited the hospital from January 2023 to January 2025 were selected as samples.All patients underwent MSCT and ultrasound diagnosis,and the diagnostic efficacy of MSCT was analyzed in comparison with pathology.Results:Pathology indicated 40 positive and 10 negative cases,ultrasound indicated 30 positive and 20 negative cases,and MSCT indicated 39 positive and 11 negative cases.The diagnostic efficacy of MSCT was higher than that of ultrasound(P<0.05).The accuracy of pathological classification of MSCT was higher than that of ultrasound(P<0.05).The detection rate of MSCT imaging indicators in AA patients was higher than that in non-AA patients(P<0.05).Conclusion:MSCT has high diagnostic efficacy in AA patients and can assist physicians in determining pathological classification.
基金Supported by the Construction Fund of Key Medical Disciplines of Hangzhou,No.0020200026Key R&D Program of Zhejiang Province,No.2023C03054.
文摘Acute appendicitis is a common surgical emergency.It is commonly caused by obstruction of the appendiceal lumen due to fecaliths,tumors,or lymphoid hyperplasia.For over a century,appendectomy has been the primary treatment for acute appendicitis.Abraham Groves performed the first open appendectomy in 1883.In 1983,Kurt Semm completed the first laparoscopic appendectomy,heralding a new era in appendectomy.However,appendectomy is associated with certain complications and a rate of negative appendectomies.Studies have suggested controversy over the impact of appendectomy on the development of inflammatory bowel disease and Parkinson’s disease,but an increasing number of studies indicate a possible positive correlation between appendectomy and colorectal cancer,gallstones,and cardiovascular disease.With the recognition that the appendix is not a vestigial organ and the advancement of endoscopic technology,Liu proposed the endoscopic retrograde appendicitis therapy.It is an effective minimally invasive alternative for treating uncomplicated acute appendicitis.Our team has developed an appendoscope with a disposable digital imaging system operated through the biopsy channel of a colonoscope and successfully applied it in the treatment of appendicitis.This article provides an overview of the progress in endoscopic treatment for acute appendicitis and offers a new perspective on the future direction of appendiceal disease treatment.
文摘BACKGROUND The maximum outer diameter(MOD)of the appendix is an essential parameter for diagnosing acute appendicitis,but there is space for improvement in ultrasound(US)diagnostic performance.AIM To investigate whether combining the ratio of the cross diameters(RATIO)of the appendix with MOD of the appendix can enhance the diagnostic performance of acute appendicitis.METHODS A retrospective study was conducted,and medical records of 233 patients with acute appendicitis and 112 patients with a normal appendix were reviewed.The MOD and RATIO of the appendix were calculated and tested for their diagnostic performance of acute appendicitis,both individually and in combination.RESULTS The RATIO for a normal appendix was 1.32±0.16,while for acute appendicitis it was 1.09±0.07.The cut-off value for RATIO was determined to be≤1.18.The area under the receiver operating characteristic curve(AUC)for diagnosing acute appendicitis using RATIO≤1.18 and MOD>6 mm was 0.870 and 0.652,respectively.There was a significant difference in AUC between RATIO≤1.18 and MOD>6 mm(P<0.0001).When comparing the combination of RATIO≤1.18 and MOD>6 mm with MOD>6 mm alone,the combination showed increased specificity,positive predictive value(PPV),and AUC.However,the sensitivity and negative predictive value decreased.CONCLUSION Combining RATIO of the appendix≤1.18 and MOD>6 mm can significantly improve the specificity,PPV,and AUC in the US diagnosis of acute appendicitis.
文摘In developed countries,the average life expectancy has been increasing and is now well over 80 years.Increased life expectancy is associated with an increased number of emergency surgical procedures performed in later age groups.Acute appendicitis is one of the most common surgical diseases,with a lifetime risk of 8%.A growing incidence of acute appendicitis has been registered in the elderly population and in the oldest groups(>80 years).Among patients>50-year-old who present to the emergency department for acute abdominal pain,15%have acute appendicitis.In these patients,emergency surgery for acute appendicitis is challenging,and some important aspects must be considered.In the elderly,surgical treatment outcomes are influenced by sarcopenia.Sarcopenia must be considered a precursor of frailty,a risk factor for physical function decline.Sarcopenia has a negative impact on both elective and emergency surgery regarding mortality and morbidity.Aside from morbidity and mortality,the most crucial outcomes for older patients requiring emergency surgery are reduction in function decline and preoperative physical function maintenance.Therefore,prediction of function decline is critical.In emergency surgery,preoperative interventions are difficult to implement because of the narrow time window before surgery.In this editorial,we highlight the unique aspects of acute appendicitis in elderly patients and the influence of sarcopenia and frailty on the results of surgical treatment.
文摘BACKGROUND Acute appendicitis is one of the most common emergency abdominal disease,and recent studies have evaluated conservative treatment using antibiotics for uncomplicated appendicitis.Although the efficacy of conservative treatment for uncomplicated appendicitis is known,its efficacy for complicated appendicitis remains unknown,so are risk factors for the conservative treatment of appendi-citis.In our institution,conservative treatment has long been the first choice for most appendicitis cases,except for perforation.Therefore,this novel study inves-tigated the outcomes of conservative treatment for uncomplicated and compli-cated acute appendicitis and the risk factors associated with conservative treat-ment.treatment.The significant and independent predictors of resistance to conservative treatment were body temperature≥37.3℃,appendicolith and Douglas sinus fluid visible on computed tomography(CT).The rate of resistance to conservative treatment was 66.7%(6/9)for patients with the above three factors,22.9%(8/35)for patients with two factors(appendicolith and body temperature≥37.3℃),16.7%(2/12)for patients with two factors(Douglas sinus fluid and appendicolith)and 11.1%(1/9)for patients with two factors(Douglas sinus fluid and body temperature≥37.3℃).CONCLUSION A temperature≥37.3℃,appendicolith and Douglas sinus fluid on CT might be clinical risk factors of resistance to conservative treatment for acute appendicitis.
文摘BACKGROUND Acute appendicitis(AA)is the most common cause of acute abdomen in children.Anesthesia significantly influences the surgical treatment of AA in children,making the scientific and effective selection of anesthetics crucial.AIM To assess the clinical effect of atropine(ATR)in combination with remifentanil(REMI)in children undergoing surgery for AA.METHODS In total,108 cases of pediatric AA treated between May 2020 and May 2023 were selected,58 of which received ATR+REMI[research group(RG)]and 50 who received REMI[control group(CG)].Comparative analyses were conducted on the time to loss of eyelash reflex,pain resolution time,recovery time from anesthesia,incidence of adverse events(AEs;respiratory depression,hypoxemia,bradycardia,nausea and vomiting,and hypotension),intraoperative responses(head shaking,limb activity,orientation recovery,safe departure time from the operating room),hemodynamic parameters[oxygen saturation(SPO2),mean arterial pressure,heart rate,and respiratory rate],postoperative sedation score(Ramsay score),and pain level[the Face,Legs,Activity,Cry,Consolability(FLACC)Behavioral Scale].RESULTS Compared with the CG,the RG showed significantly shorter time to loss of eyelash reflex,pain resolution,recovery from anesthesia,and safe departure from the operating room.Furthermore,the incidence rates of overall AEs(head shaking,limb activity,etc.)were lower,and influences on intraoperative hemodynamic parameters and stress response indexes were fewer.The Ramsay score at 30 min after extubation and the FLACC score at 60 min after extubation were significantly lower in the RG than in the CG.CONCLUSION ATR+REMI is superior to REMI alone in children undergoing AA surgery,with a lower incidence of AEs,fewer influences on hemodynamics and stress responses,and better post-anesthesia recovery.
文摘Acute appendicitis(AA) develops in a progressive and irreversible manner, even if the clinical course of AA can be temporarily modified by intentional medications. Reliable and real-time diagnosis of AA can be made based on findings of the white blood cell count and enhanced computed tomography. Emergent laparoscopic appendectomy(LA) is considered as the first therapeutic choice for AA. Interval/delayed appendectomy at 6-12 wk after disease onset is considered as unsafe with a high recurrent rate during the waiting time. However, this technique may have some advantages for avoiding unnecessary extended resection in patients with an appendiceal mass. Nonoperative management of AA may be tolerated only in children. Postoperative complications increase according to the patient's factors, and temporal avoidance of emergent general anesthesia may be beneficial for high-risk patients. The surgeon's skill and cooperation of the hospital are important for successful LA. Delaying appendectomy for less than 24 h from diagnosis is safe. Additionally, a semi-elective manner(i.e., LA within 24 h after onset of symptoms) may be paradoxically acceptable, according to the factors of the patient, physician, and institution. Prompt LA is mandatory for AA. Fortunately, the Japanese government uses a universal health insurance system, which covers LA.
文摘Pylephlebitis, a rare complication of acute appendicitis, is defined as thrombophlebitis of the portal venous system. Pylephlebitis usually occurs due to secondary infection in the region drained into the portal system. We report a case of pylephlebitis caused by acute appendicitis. The patient was transferred from a private clinic 1 wk after appendectomy with the chief complaints of high fever and abdominal pain. He was diagnosed with pylephlebitis of the portal vein and superior mesenteric vein by CT-scan. The patient was treated with antibiotics and anticoagulation therapy, and discharged on the 25th day and follow-up CT scan showed a cavernous transformation of portal thrombosis.
文摘BACKGROUND Appendectomy is the procedure of choice for the treatment of acute appendicitis.However,surgery may not be appropriate for patients with coexisting severe illness or comorbidities such as acute pancreatitis(AP).Endoscopic retrograde appendicitis treatment(ERAT)may be a novel alternative to surgery for treating such patients where existing medical therapies have failed.CASE SUMMARY We report 2 cases of moderately severe AP who developed acute uncomplicated appendicitis during their hospital stay and did not respond to traditional medical therapy.One patient had moderately severe AP due to hyperlipidemia,while the other patient had a gallstone induced by moderately severe AP.Neither patient was fit to undergo an appendectomy procedure because of the concurrent AP.Therefore,the alternative and minimally invasive ERAT was considered.After written informed consent was collected from the patients,the ERAT procedure was performed.Both patients exhibited fast postoperative recovery after ERAT with minimal surgical trauma.CONCLUSION ERAT is a safe and effective minimally invasive endoscopic procedure for acute appendicitis in patients with coexistent AP.
文摘Acute appendicitis(AA)is the most common acute abdomen,and appendectomy is the most common nonelective surgery performed worldwide.Despite the long history of understanding this disease and enhancements to medical care,many challenges remain in the diagnosis and treatment of AA.One of these challenges is the timing of appendectomy.In recent decades,extensive studies focused on this topic have been conducted,but there have been no conclusive answers.From the onset of symptoms to appendectomy,many factors can cause delay in the surgical intervention.Some are inevitable,and some can be modified and improved.The favorable and unfavorable results of these factors vary according to different situations.The purpose of this review is to discuss the causes of appendectomy delay and its risk-related costs.This review also explores strategies to balance the positive and negative effects of delayed appendectomy.
文摘BACKGROUND Acute appendicitis with mesenteric vein thrombosis(MVT)is an uncommon condition and usually lacks specific clinical manifestations,which leads to a high rate of misdiagnosis or delayed diagnosis,especially when it is accompanied by other abdominal diseases.Prompt and accurate recognition is vital for treatment and prognosis.CASE SUMMARY A 37-year-old woman had a history of acute metastatic right lower abdominal pain,nausea,and fever.A contrast-enhanced computed tomography(CT)scan showed a filling defect in the mesenteric vessels.The patient was diagnosed with acute appendicitis complicated by MVT and was treated with anticoagulation and intravenous antibiotics.The follow-up CT scan showed full resolution of the thrombosis and inflammation.CONCLUSION Clinical awareness is essential for recognizing MVT,especially when it is accompanied by other common acute abdominal diseases,such as acute appendicitis.Contrast-enhanced CT is helpful for the diagnosis of MVT and is recommended for patients with acute abdominal diseases.
