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Objective: To compare diagnostic accuracy of contrast enhanced low-dose computed tomography (CT) accomplished in the OPTICAP trial phantom phase to standard CT in patients with suspected acute appendicitis. Background: Increasing ...
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Objective: To compare diagnostic accuracy of contrast enhanced low-dose computed tomography (CT) accomplished in the OPTICAP trial phantom phase to standard CT in patients with suspected acute appendicitis. Background: Increasing use of CT as the gold standard in diagnosing acute appendicitis has raised concerns regarding radiation exposure. Unenhanced low-dose CT protocols have shown similar diagnostic accuracy with standard CT for diagnosing appendicitis. To our knowledge, there are no other trials in which the same patient with suspected acute appendicitis underwent both standard and low-dose CT allowing interpatient comparison. Methods: OPTICAP is an interpatient protocol sequence randomized noninferiority single-center trial performed at Turku University Hospital between November, 2015 and August, 2016. Sixty patients with suspected acute appendicitis and body mass index <30 kg/m(2)were enrolled to undergo both standard and low-dose contrast enhanced CT scans, which were categorized as normal, uncomplicated or complicated appendicitis by 2 radiologists in blinded manner. All patients with CT confirmed appendicitis underwent appendectomy to obtain histopathology. Results: The low-dose protocol was not inferior to standard protocol in terms of diagnostic accuracy; 79% [95% confidence interval (CI) 66%-89%) accurate diagnosis in low-dose and 80% (95% CI 67%-90%) in standard CT by primary radiologist. Accuracy to categorize appendicitis severity was 79% for both protocols. The mean radiation dose of low-dose CT was significantly lower compared with standard CT (3.33 and 4.44 mSv, respectively). Conclusion: Diagnostic accuracy of contrast enhanced low-dose CT was not inferior to standard CT in diagnosing acute appendicitis or distinguishing between uncomplicated and complicated acute appendicitis in patients with a high likelihood of acute appendicitis. Low-dose CT enabled significant radiation dose reduction.
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Objectives: To investigate the influence of Coronavirus Disease 2019 on incidence of acute complex appendicitis and management of acute appendicitis. Methods: Patients undergoing acute appendicitis surgery in a single center durin...
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Objectives: To investigate the influence of Coronavirus Disease 2019 on incidence of acute complex appendicitis and management of acute appendicitis. Methods: Patients undergoing acute appendicitis surgery in a single center during the COVID-19 epidemic from January to September 2020 and patients from January to September 2019 were taken as the epidemic group and control group respectively. The clinical characteristics and surgical pathological information were compared between the two groups. The primary outcome measure was complex appendicitis. Results: A total of 235 patients were included in the study, containing 106 in the epidemic group and 129 in the control group. The patients in the epidemic group had a significantly longer interval from the onset of symptoms to registration (37.92 h vs 24.57 h, P = 0.028), from registration to admission (18.69 h vs 8.04 h, P < 0.001), and from admission to surgery (7.23 h vs 6.52 h, P = 0.016). The epidemic group had a higher incidence of suppurative appendicitis (86.8% vs 76.0%, P = 0.036) and a higher incidence of complex appendicitis (35.8% vs 19.4%, P = 0.005). Conclusion: Higher incidence of acute complex appendicitis seemed to occur during COVID-19 outbreak. (c) 2021 Published by Elsevier Inc.
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The World Society of Emergency Surgery (WSES) was established in 2007. The objectives set forth by the society, as enumerated in the mission statement, is: “The overall goals include the promotion of the specialty of emergency su...
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The World Society of Emergency Surgery (WSES) was established in 2007. The objectives set forth by the society, as enumerated in the mission statement, is: “The overall goals include the promotion of the specialty of emergency surgery as part of the emerging discipline of acute care surgery via academic exchange in an effort to further training and education as well as translational research in the specialty’.
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The appendix is the smallest, nonfunctional segment of gastrointestinal tract. Appendicitis is the most common surgical emergency, but the clinical diagnosis often is not straightforward and can be very challenging. Delayed diagno...
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The appendix is the smallest, nonfunctional segment of gastrointestinal tract. Appendicitis is the most common surgical emergency, but the clinical diagnosis often is not straightforward and can be very challenging. Delayed diagnosis can lead to increased morbidity due to such complications as appendiceal perforation, abscess formation, sepsis, peritonitis, bowel obstruction, and even death. Useful diagnostic modalities include ultrasonography and CT. Prior to making the diagnosis of appendicitis, one should be able to identify normal appendix. This review article is designed to permit the radiologist to 1) identify the normal appendix on nonenhanced and enhanced CT scans; 2) recognize pitfalls, artifacts, and mimics of the appendix; and 3) detect both the obvious and the subtle findings of appendicitis and its complications.
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PurposeAppendiceal tumors are rare, but high neoplasm rates have been reported at interval appendectomy after periappendicular abscess. Non-operative management of uncomplicated acute appendicitis has shown promising results. The ...
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PurposeAppendiceal tumors are rare, but high neoplasm rates have been reported at interval appendectomy after periappendicular abscess. Non-operative management of uncomplicated acute appendicitis has shown promising results. The data on appendiceal tumor incidence and presentation among acute appendicitis patients is limited, especially in patient cohorts differentiating between uncomplicated and complicated acute appendicitis. Objective was to assess appendiceal tumor incidence and tumor association to appendicitis in patients with uncomplicated and complicated acute appendicitis.MethodsThis nationwide population-based registry study was conducted from 2007 to 2013. The Finnish Cancer Registry and the National Institute for Health Registry were used to combine data on all appendiceal tumors and acute appendicitis diagnosis with medical reports evaluated at eight study hospitals.ResultsAltogether, 840 appendiceal tumors were identified, and out of these, 504 patient reports were reviewed, including 472 patients in this study. Tumor was diagnosed at appendectomy for suspected acute appendicitis in 276 patients (58%). In the whole study, histologically acute appendicitis and tumor were both present in 53% (n=250), and out of these, 41% (n=102) were complicated and 59% (n=148) uncomplicated acute appendicitis. The associated tumor risk was significantly higher in complicated acute appendicitis compared with uncomplicated cases (3.24% vs. 0.87%, p<0.001). Overall tumor prevalence among acute appendicitis patients was 1.24%.ConclusionsAppendiceal tumor prevalence in acute appendicitis was low. Tumor risk was significantly higher in complicated acute appendicitis compared with uncomplicated acute appendicitis. The risk of missed appendiceal tumors related to antibiotic therapy of uncomplicated acute appendicitis is very low.
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Over the last 5 years, acute appendicitis (AA) is definitely drawing the scientific attention. As the timing in efficiently and promptly treating patients with AA is essential, any potential blind spot in understanding the disease...
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Over the last 5 years, acute appendicitis (AA) is definitely drawing the scientific attention. As the timing in efficiently and promptly treating patients with AA is essential, any potential blind spot in understanding the disease should be clarified. Consequently, physicians will be able to address the patient towards the more appropriate therapeutic pathway (antibiotic or surgery) and avoid any harmful delay. Currently, neither surgery nor antibiotic seem offer a remarkable advantage to the patients therefore surgery remains the gold-standard in treating AA in accordance to the historical dogma.
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Intraluminal gas and an appendiceal diameter measuring up to 10 mm on CT are common findings of a normal appendix. Recognition of a normal appendix is required to exclude appendicitis. An enlarged appendix with periappendiceal inf...
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Intraluminal gas and an appendiceal diameter measuring up to 10 mm on CT are common findings of a normal appendix. Recognition of a normal appendix is required to exclude appendicitis. An enlarged appendix with periappendiceal inflammation is the most common finding of acute appendicitis. Fat stranding may present in different patterns depending on location of the appendix.
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Background During pandemic, admissions for surgical emergencies dropped down dramatically. Also acute appendicitis decreased. The aim of the present study was to evaluate the change in volume and clinical presentation of patients ...
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Background During pandemic, admissions for surgical emergencies dropped down dramatically. Also acute appendicitis decreased. The aim of the present study was to evaluate the change in volume and clinical presentation of patients with acute appendicitis during pandemic and the variation in treatment. Methods This is a retrospective study of patients admitted in 11 Italian hospital for acute appendicitis during the lockdown period (March-April 2020) compared with the same period of the previous 2 years (2018-2019). The number and the rate of complicated and non-complicated acute appendicitis were recorded and compared between the two study periods; non-operative vs operative treatment and negative appendectomy rate were also recorded. Results The study included 532 patients, 112 in the study period and 420 in the control period; Hospital admission for acute appendicitis dropped by 46% (OR 0.516 95% CI 0.411-0.648 p < 0.001) during the 2020 lockdown. The number of complicated acute appendicitis did not change (- 18%, OR 0.763 95% CI 0.517-1.124 p = 0.1719), whereas the number of non-complicated acute appendicitis significantly decreased (- 56%, OR 0.424 95% CI 0.319-0.564 p < 0.001). Non-operative treatment rate remained similar (12.1% vs. 11.6% p = 0.434). The negative appendectomy rate also significantly decreased (6.1% vs. 17.3%, p = 0.006). Conclusions The present study found a significant reduction of both admissions for non-complicated acute appendicitis and negative appendectomy rate during the pandemic period. Conversely, admissions for complicated acute appendicitis did not change. Trial registration: NCT04649996.
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INTRODUCTION: Acute appendicitis of amebic origin is considered a rare cause of acute appendicitis. METHODS: The clinical notes for 4093 patients over the age of 16 who had undergone appendectomy were reviewed. Particular attentio...
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INTRODUCTION: Acute appendicitis of amebic origin is considered a rare cause of acute appendicitis. METHODS: The clinical notes for 4093 patients over the age of 16 who had undergone appendectomy were reviewed. Particular attention was paid to the histopathologic results, separating out those cases where trophozoites were seen in the appendix. These cases were considered to be of amebic origin. RESULTS: A total of 93 cases reported lesions suggestive of amebiasis (2.3%). This study analyzed 86 of these cases. Comparing the cases in this study against the cases of patients with acute appendicitis in general (excluding the cases of amebic origin), no differences were found in relation to the distribution or presentation according to sex or in the degree of inflammation of the appendix, the incidence of surgical wound infection, or general complications. By contrast, the study noted a statistically significant difference in the age at presentation: Acute appendicitis of amebic origin presents principally among those under 20 years of age and is accompanied by a higher frequency of fecal fistula (2.3%). CONCLUSIONS: Acute appendicitis of amebic origin is not seen frequently, and in general it does not behave any differently from other cases of acute appendicitis, except in its earlier presentation and its greater incidence of fecal fistula. The condition is suspected clinically whenever a cecum of hard, "cardboard-like" consistency is discovered.
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