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PubMed2005

Evaluating diagnostic accuracy in appendicitis using administrative data.

BACKGROUND: Research techniques using administrative data have been used to assess quality of care in the management of appendicitis, but their validity has not been assessed. This study assessed the validity of a research technique using administrative data to determine whether patients undergoing an appendectomy actually had appendicitis or if they had a negative appendectomy (NA). MATERIALS AND METHODS: A retrospective study of patients at Group Health Cooperative of Puget Sound undergoing appendectomy from 1991-1999 was conducted to compare the accuracy of administrative codes with data abstracted from medical records. RESULTS: Of 1823 nonincidental appendectomies (mean age 31 +/- 18.6 years, 49.6% female), 280 did not have appendicitis by criteria applied to administrative data (15.4%). The accuracy of this method for determining appendicitis was determined by medical record evaluation revealing sensitivity (98.6%), specificity (48.6%), positive predictive value for appendicitis (83.8%), and negative predictive value for NA (70.4%). When the administrative-data technique did not classify a patient as having had appendicitis, chart-abstracted data indicated appendicitis in 6.4%, and an incorrectly labeled incidental appendectomy in 23.2%. The administrative-data technique for detecting NA erroneously included many cases of incidental appendectomy and missed many cases of clinically confirmed NA. More than half of clinical NAs were missed by the administrative technique. CONCLUSIONS: In this setting, the sensitivity of administrative-data techniques for the detection of appendicitis was excellent, but their adequacy for identifying patients undergoing NA was limited. The use of this technique as a quality measure should be reconsidered.

Adolescent↗
PubMed1990

Acute appendicitis in the pregnant patient.

Acute appendicitis is the most common surgical problem in pregnancy requiring emergent intervention. To establish a contemporary patient profile and formulate an effective management strategy, a retrospective review was conducted of 84 pregnant patients who underwent laparotomy with a preoperative diagnosis of acute appendicitis. Gestational stage at presentation included the first trimester in 27 patients (32%), the second trimester in 37 patients (44%), the third trimester in 13 patients (16%), and the puerperium in 7 patients (8%). Fifty-four patients (64%) had pathologically proven acute appendicitis; the incidence did not vary by trimester. Other intra-abdominal conditions were detected in 15 patients (18%). There were no significant differences between patients with positive and negative laparotomies (or among trimesters) regarding frequency of presenting symptoms and signs or laboratory results. Operation occurred within 24 hours of symptom onset in 19 of 54 (35%) instances of proven acute appendicitis. Perforation occurred in 23 of 54 patients (43%), all of whom had symptoms exceeding 24 hours (p less than 0.0005). Five instances of perinatal death and one case of extreme perinatal morbidity were associated with negative laparotomies; only one of these was attributed to operation itself. No adverse long-term maternal morbidity or mortality occurred. Wound infection developed in seven cases of acute appendicitis (six perforated) and two negative explorations. We conclude that (1) gestational physiologic changes obscure the accurate diagnosis of acute appendicitis; (2) the natural history of acute appendicitis is not affected by trimester of presentation; and (3) adverse sequelae of acute appendicitis are obviated by prompt operative exploration and prevention of appendiceal perforation.

Acute Disease↗
PubMed1996

Ultrasonography as an adjunct in the diagnosis of acute appendicitis: a 4-year experience.

This study was designed to evaluate the sensitivity and specificity of abdominal ultrasonography as a diagnostic modality in a large series of children who presented with possible appendicitis. From August 1990 to July 1994, 452 children (203 boys, 249 girls) with an average age of 11 years (range, 1 to 20 years) underwent graded compression ultrasonography of the right lower quadrant of the abdomen for the evaluation of possible appendicitis. In the first 18 months of the study all patients with the possible diagnosis of appendicitis (group I; 180 patients) had abdominal ultrasonography after members of the surgical team evaluated and documented their findings in the medical record. In the second study period (30 months), abdominal ultrasonography was recommended only when the clinical diagnosis of acute appendicitis was equivocal (group II; 272 patients). Abdominal ultrasonography was performed using the graded compression technique with a 5.0-MHz linear array transducer. A positive ultrasound study for appendicitis was defined as the presence of an enlarged noncompressible appendix with an outer wall to outer wall diameter of greater than 6 mm, the presence of a complex mass, or the presence of an appendicolith. The sonographic data were correlated with surgical and pathological findings. Appendicitis was confirmed in 112 of the 452 cases. In 17 of these, the appendix was perforated. In the overall group of 452 children, abdominal ultrasonography had a sensitivity of 90%, specificity of 96%, and accuracy of 95%. There was no significant morbidity in the 11 patients with a false-negative study result. All 11 patients had an uncomplicated appendectomy. There were 11 false-positive results; 10 of these patients had a negative laparotomy result (negative laparatomy rate, 8.9%). For the two groups, the sensitivity and specificity of ultrasonography in the diagnosis of appendicitis were equivalent (group 1: 88% sensitivity, 96% specificity; group 2: 92% sensitivity, 97% specificity). On the basis of the high sensitivity and specificity rates, ultrasonography of the appendix can be a useful adjunct to standard examination in the diagnosis of acute appendicitis.

Abdominal Pain↗
PubMed1999

Does early ultrasonography affect management of pediatric appendicitis? A prospective analysis.

BACKGROUND: Appendicitis remains a difficult diagnosis in children. Ultrasonography is increasingly used for the diagnosis of appendicitis, although the proper clinical role for this test remains unclear. METHODS: To evaluate the clinical utility of ultrasonography in appendicitis, the authors analyzed prospectively all children evaluated for possible appendicitis from January 1 through December 31, 1997. Children with a high clinical suspicion of appendicitis were referred for surgery (n = 122). Children with equivocal findings of appendicitis were referred for early ultrasonography (EUS) and formed the study cohort (n = 103). An initial management plan was made to operate or observe each patient, and a risk of appendicitis (doubtful, possible, probable) was assigned by a pediatric surgery fellow. EUS was then performed, and its effect on management was assessed. RESULTS: Using clinical judgment to operate at initial presentation, the sensitivity was 38% and specificity was 95%. Using EUS alone, the sensitivity was 87% and specificity was 88%. The management of 30 of 103 patients (30%) was changed after EUS, including a decision to operate in 28 patients and a decision not to operate in two patients. CONCLUSIONS: EUS appears to have substantial clinical utility in children with equivocal findings of appendicitis, and its use complements the clinical management. The use of EUS can improve patient care and reduce hospital resource utilization.

Adolescent↗
PubMed1988

Urological manifestations of acute appendicitis.

The diagnosis of appendicitis may be difficult to establish even for the experienced surgeon. Considerable variability in presenting symptoms and signs, resulting in part from the numerous locations in which the appendix may be found, contributes to diagnostic insecurity. Appendicitis that mimics acute disorders of the genitourinary tract is a rare cause of diagnostic confusion. The association of appendicitis with abnormal urinary sediment or ureteral obstruction has been reported previously. We report 3 cases of proved appendicitis that presented with other symptoms suggestive of acute urological disorders (gross hematuria, acute prostatis and acute pyelonephritis). While gross hematuria caused by appendicitis has been reported previously, cases of appendicitis mimicking acute prostatitis or rupture of a renal calix with extravasation of urine following ureteral obstruction have not been described. Recognition of unusual manifestations of appendicitis is essential in current surgical practice. Appendicitis should be included in the differential diagnosis of acute urological disorders.

Acute Disease↗
PubMed1981

Surgical pathology of acute appendicitis.

Pathologic findings and clinicopathologic correlations in 276 consecutive appendectomies performed in a university hospital are reviewed. In 59 cases, appendectomy was incidental to another elective procedure. In the other 217 cases exploration was performed as an emergency, and acute appendicitis was present in 160 of the cases (74 per cent); 54 of these were complicated by perforation. In the remaining 57 cases there was either some other pathologic process clinically distinct from appendicitis or no identifiable source of the preoperative symptoms. The major findings were as follows: (1) Although appendicitis appears to be the result of initial mucosal injury, not all inflamed appendices show clear evidence of lumen obstruction by a fecalith or another mechanism. (2) Perforation, which greatly increases the morbidity in appendicitis and disproportionately affects children, is the consequence of transmural necrosis and is related much more to prolonged symptoms prior to surgery than to the presence of a fecalith or any other evidence of lumen obstruction. (3) The clinical course of appendicitis varies enormously, and the duration of symptoms has a wide range that is partly independent of the pathologic findings (which may include evidence of considerable chronic inflammation). The conclusions are that the current widely accepted practice of prompt exploration on suspicion of appendicitis is fully justified, that the inflammation in appendicitis may have quite different rates of progression from patient to patient, and that the etiopathogenesis of appendicitis may not be uniform and in some cases may involve important immunologic factors.

Acute Disease↗
PubMed2000

Diagnostic value of interleukin-6 and C-reactive protein in acute appendicitis.

The aim of this study is prospectively to evaluate the serum C-reactive protein (CRP) and interleukin-6 (IL-6) levels in detection of acute appendicitis in patients with right iliac fossa pain. Data were collected in prospective manner on 102 consecutive patients with right iliac fossa pain. Laparotomy was performed for suspected acute appendicitis for 55 of the 102 patients, of whom 49 patients had appendicitis, 6 patients non-appendicitis (NA), and the other 47 patients had nonspecific abdominal pain (NSAP) and they did not undergo operation. Among those with appendicitis 31 had acute appendix (AA), 8 had gangrenous appendix (GA), and 10 had perforated appendix (PA). The WBC and CRP the mean (SEM) values were significantly different in AA, GA, and PA groups compared with NSAP and NA groups (P < 0.05). Although the mean IL-6 levels were significantly different only in PA group than the others groups (P < 0.05). The sensitivity and specificity of serum CRP measurements were calculated as 96% and 87%, respectively whereas these were 33% and 83% for IL-6 levels for the diagnosis of the acute appendicitis. As a result, measurement of the CRP levels and WBC have an additional diagnostic value on the diagnosis of the acute appendicitis but determination of IL-6 levels which added to the test combination of WBC and CRP, the sensitivity for the diagnosis of the acute appendicitis was not changed whereas the specificity was decreased to 66%.

Acute Disease↗
PubMed2002

Serum interleukin-6 measurement in the diagnosis of acute appendicitis.

BACKGROUND: Many attempts have been made to determine ways of decreasing the negative laparotomy rate after a clinical diagnosis of acute appendicitis. The aim of the present study was to determine the effectiveness of serum interleukin-6 (IL-6) concentration in the diagnosis of appendicitis, and in the prevention of non-therapeutic laparotomy in patients with right iliac fossa pain. METHODS: Serum IL-6 concentrations were measured at admission in 77 consecutive patients who were operated on for the treatment of acute appendicitis. The final diagnosis was established by histopathological examination. The sensitivity, specificity and accuracy of IL-6 concentrations in the diagnosis of appendicitis were calculated. RESULTS: The negative laparotomy rate was 17% (13/77) in this series. The IL-6 level was elevated in seven of 13 patients (54%; false positive) with a normal appendix. The IL-6 level was normal in 10/64 patients (16%; false negative) with acute appendicitis. The IL-6 level was highly elevated in all patients with perforated appendicitis. The sensitivity, specificity, accuracy, and positive and negative predictive values were calculated as 84, 46, 78, and 89 and 38%, respectively. CONCLUSIONS: Unacceptably high false negative and positive rates decrease the accuracy of the serum IL-6 test for appendicitis. Serum IL-6 measurement is not of benefit in increasing the accuracy of the diagnosis of appendicitis. Serum IL-6 results are not useful for preventing negative laparotomies in the majority of patients with right iliac fossa pain.

Adolescent↗
PubMed2002

Pediatric appendicitis score.

BACKGROUND/PURPOSE: Morbidity in children treated with appendicitis results either from late diagnosis or negative appendectomy. A Prospective analysis of efficacy of Pediatric Appendicitis Score for early diagnosis of appendicitis in children was conducted. METHODS: In the last 5 years, 1,170 children aged 4 to 15 years with abdominal pain suggestive of acute appendicitis were evaluated prospectively. Group 1 (734) were patients with appendicitis and group 2 (436) nonappendicitis. Multiple linear logistic regression analysis of all clinical and investigative parameters was performed for a model comprising 8 variables to form a diagnostic score. RESULTS: Logistic regression analysis yielded a model comprising 8 variables, all statistically significant, P <.001. These variables in order of their diagnostic index were (1) cough/percussion/hopping tenderness in the right lower quadrant of the abdomen (0.96), (2) anorexia (0.88), (3) pyrexia (0.87), (4) nausea/emesis (0.86), (5) tenderness over the right iliac fossa (0.84), (6) leukocytosis (0.81), (7) polymorphonuclear neutrophilia (0.80) and (8) migration of pain (0.80). Each of these variables was assigned a score of 1, except for physical signs (1 and 5), which were scored 2 to obtain a total of 10. The Pediatric Appendicitis Score had a sensitivity of 1, specificity of 0.92, positive predictive value of 0.96, and negative predictive value of 0.99. CONCLUSION: Pediatric appendicitis score is a simple, relatively accurate diagnostic tool for accessing an acute abdomen and diagnosing appendicitis in children.

Abdominal Pain↗
PubMed1988

[Ultrasonics in acute appendicitis. A prospective study].

In a prospective study 404 unselected patients suspected of having acute appendicitis were examined by ultrasound, the results being compared with the initial clinical findings. Acute appendicitis was established in 27.2%, confirmed by histology. The overall accuracy of ultrasonography in relation to the diagnosis of appendicitis was 95.5%, 95.1% when positive, 95.7% when negative. An acutely inflamed appendix could not be demonstrated by ultrasound in 13 patients (sensitivity 88.2%), while in five there was a false-positive ultrasound result (specificity 98.3%). Complicated appendicitis with perforation occurred in 22 patients (20%): ultrasound sensitivity in this situation was 91%. Especially when the clinical picture was unclear (34.5% of all cases of appendicitis) a definitive diagnosis of acute appendicitis was made both earlier and more certainly by ultrasonography. Further-more, in many instances ultrasound was able to demonstrate other serious disease in the differential diagnosis from acute appendicitis. Negative laparotomy rate was lowered from 21.9% to 11.4% by taking into account ultrasonographic findings. Thus ultrasonography proved to be an important method as an imaging technique and in the differential diagnosis of acute appendicitis.

Acute Disease↗
PubMed1994

Appendicectomy for acute appendicitis and for other conditions: an epidemiological study.

BACKGROUND: Appendicectomy is one of the commonest operations in most developed countries, especially in children and young adults. We used routine abstracts of hospital inpatient records to study the demographic and temporal profiles of emergency appendicectomy for acute appendicitis and appendicectomy in other circumstances. METHODS: Records held in the Oxford record linkage study (ORLS) from 1970-1986 inclusive were analysed. Age- and sex-specific admission rates were studied, subdividing appendicectomy into three main categories: emergency appendicectomy for acute appendicitis, emergency appendicectomy as the main operation without appendicitis recorded as a diagnosis, and prophylactic or incidental appendicectomy with other operations but without appendicitis. RESULTS: A total of 47,505 records of appendicectomy were analysed. Emergency appendicectomy for acute appendicitis was more common in males than females, peaked in the 10-19 year age groups, and declined over time. Emergency appendicectomy without appendicitis was more common in women than men (female to male ratio 1.8:1), peaked at age 15-19 years and did not decline over time. Incidental appendicectomy was much commoner in women (female to male ratio 3:1), peaked at older ages than the first two groups, and declined significantly over time. CONCLUSIONS: The demographic profiles of patients in these categories were quite different. The data on trends suggest confirmation of a true decline in acute appendicitis, no decline for conditions which may mimic it, and a decline in the use of prophylactic and incidental appendicectomy. The operations in the latter categories--appendicectomy without acute appendicitis--were much commoner in women than men and their appropriateness would be worthwhile topics for medical audit.

Acute Disease↗
PubMed1989

Incidence and case fatality rates for acute appendicitis in California. A population-based study of the effects of age.

In 1984, 24,794 appendectomies and abscess drainage procedures were performed for acute appendicitis in California hospitals. Analysis of hospital discharge abstracts revealed age- and sex-specific incidence rates and in-hospital case fatality rates for acute appendicitis lower than previously reported. In persons aged 60 years and older, the case fatality rate for nonperforating appendicitis with appendectomy was 0.7% and for perforating appendicitis and abscess 2.4%. Surgery was delayed beyond the day of admission in 21% of persons aged 40-59 years, 29% of persons aged 60-79 years, and 47% of persons aged 80 years and over. The proportion of cases with perforation increased from 22% to 75% between ages 20 and 80 years. The population incidence of perforating appendicitis changed little after age 20 years, while the incidence of nonperforating cases declined sharply. The high proportion of appendicitis cases with perforation among the elderly may be due to the decreased incidence of nonperforating appendicitis in the elderly and not to a greater propensity for perforation, as previously proposed. Most elderly in California receive timely surgery for appendicitis and tolerate it better than previously reported. Diminished tolerance for intra-abdominal infection may be the primary determinant of the increase in case fatality with age.

Acute Disease↗
PubMed1990

The epidemiology of appendicitis and appendectomy in the United States.

To describe the epidemiology of appendicitis and appendectomy in the United States, the authors analyzed National Hospital Discharge Survey data for the years 1979-1984. Approximately 250,000 cases of appendicitis occurred annually in the United States during this period, accounting for an estimated 1 million hospital days per year. The highest incidence of primary positive appendectomy (appendicitis) was found in persons aged 10-19 years (23.3 per 10,000 population per year); males had higher rates of appendicitis than females for all age groups (overall rate ratio, 1.4:1). Racial, geographic, and seasonal differences were also noted. Appendicitis rates were 1.5 times higher for whites than for nonwhites, highest (15.4 per 10,000 population per year) in the west north central region, and 11.3% higher in the summer than in the winter months. The highest rate of incidental appendectomy was found in women aged 35-44 years (43.8 per 10,000 population per year), 12.1 times higher than the rate for men of the same age. Between 1970 and 1984, the incidence of appendicitis decreased by 14.6%; reasons for this decline are unknown. A life table model suggests that the lifetime risk of appendicitis is 8.6% for males and 6.7% for females; the lifetime risk of appendectomy is 12.0% for males and 23.1% for females. Overall, an estimated 36 incidental procedures are performed to prevent one case of appendicitis; for the elderly, the preventive value of an incidental procedure is considerably lower.

Adolescent↗
PubMed1993

Missed appendicitis in a pediatric emergency department.

UNLABELLED: Appendicitis is the most common cause of abdominal pain requiring surgery in children. Missed appendicitis is also a frequent cause of professional liability in an emergency department (ED). A retrospective review of all patients with appendicitis diagnosed in the ED was undertaken to identify: 1) how many patients required more than one visit to diagnose appendicitis and 2) the clinical characteristics that distinguished the patients who visited twice from patients who were diagnosed on the first visit. A total of 87 patients with appendicitis were seen by pediatricians in the ED from 1987 to 1989. The patients included 43 girls and 44 boys (mean age, 8.9 years). Six patients (7%) were seen twice before the diagnosis of appendicitis was made. They returned to the ED on average 29 hours after the first visit. The ED discharge diagnosis of the six "missed" patients included: probable Campylobacter (n = 1), viral urinary tract infection (n = 1), gastroenteritis (n = 2), and abdominal pain (n = 2). The six missed patients were different from the other patients with appendicitis. They were more likely to have a normal appetite, to have diarrhea, and to be afebrile. All the patients had at least two of the four following signs and symptoms: vomiting, tenderness, guarding, and right lower quadrant (RLQ) pain. At the time of surgery, 23/81 (28%) of the one-visit group had a ruptured appendix, whereas 3/6 (50%) of the missed patients had a ruptured appendix. CONCLUSIONS: 1) Seven percent of the patients were seen twice in our ED before the diagnosis of appendicitis was made.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed2006

Is it safe to delay appendectomy in adults with acute appendicitis?

OBJECTIVE: To examine whether delayed surgical intervention in adult patients with acute appendicitis is safe by correlating the interval from onset of symptoms to operation (total interval) with the degree of pathology and incidence of postoperative complications. SUMMARY BACKGROUND DATA: Prompt appendectomy has long been the standard of care for acute appendicitis because of the risk of progression to advanced pathology. This time-honored practice has been recently challenged by studies in pediatric patients, which suggested that acute appendicitis can be managed in an elective manner once antibiotic therapy is initiated. No such data are available in adult patients with acute appendicitis. METHODS: A retrospective review of 1081 patients who underwent an appendectomy for acute appendicitis between 1998 and 2004 was conducted. The following parameters were monitored and correlated: demographics, time from onset of symptoms to arrival at the emergency room (patient interval) and from arrival to the emergency room to the operating room (hospital interval), physical, computed tomography (CT scan) and pathologic findings, complications, length of stay, and length of antibiotic treatment. Pathologic state was graded 1 (G1) for acute appendicitis, 2 (G2) for gangrenous acute appendicitis, 3 (G3) for perforation or phlegmon, and 4 (G4) for a periappendicular abscess. RESULTS: The risk of advanced pathology, defined as a higher pathology grade, increased with the total interval. When this interval was <12 hours, the risk of developing G1, G2, G3, and G4, was 94%, 0%, 3%, and 3%, respectively. These values changed to 60%, 7%, 27%, and 6%, respectively, when the total interval was 48 to 71 hours and to 54%, 7%, 26%, and 13% for longer than 71 hours. The odds for progressive pathology was 13 times higher for the total interval >71 hours group compared with total interval<12 hours (95% confidence interval = 4.7-37.1). Although both prolonged patient and hospital intervals were associated with advanced pathology, prehospital delays were more profoundly related to worsening pathology compared with in-hospital delays (P < 0.001). Advanced pathology was associated with tenderness to palpation beyond the right lower quadrant (P < 0.001), guarding (P < 0.001), rebound (P < 0.001), and CT scan findings of peritoneal fluid (P = 0.01), fecalith (P = 0.01), dilation of the appendix (P < 0.001), and perforation (P < 0.001). Increased length of hospital stay (P < 0.001) and antibiotic treatment (P < 0.001) as well as postoperative complications (P < 0.001) also correlated with progressive pathology. CONCLUSION: In adult patients with acute appendicitis, the risk of developing advanced pathology and postoperative complications increases with time; therefore, delayed appendectomy is unsafe. As delays in seeking medical help are difficult to control, prompt appendectomy is mandatory. Because these conclusions are derived from retrospective data, a prospective study is required to confirm their validity.

Acute Disease↗
PubMed1989

Acute abdominal pain and appendicitis in north east Thailand.

In a survey of emergency admissions to hospital in rural Thailand, acute appendicitis was the commonest cause of acute abdominal pain. Estimates of the incidence of appendicitis, in two series comprising a total of 356 patients, at 3.2 and 3.7 per 10,000 population per year, were relatively high compared with reports from other warm climate countries. In comparison with 1825 cases in studies sponsored by the Organisation Mondiale de Gastroenterologie (OMGE), Thai patients with acute appendicitis were older, presented late and experienced more complications than those in 14 other countries. In Khon Kaen only 2-3% of the cases were children aged 0-9 years, compared with 9-26% in the OMGE series. In patients admitted to hospital with acute abdominal pain in Thailand, acute appendicitis was diagnosed more often than non-specific abdominal pain. The converse was true in the OMGE series. This may reflect the longer distances travelled to hospital by many patients and delays between onset of symptoms and admission to hospital. Acute appendicitis was the commonest definitive diagnosis in both series. This survey indicates that relatively high rates of acute appendicitis may occur in populations eating traditional diets. The results are consistent with the recently described hypothesis of an infective aetiology and increases in appendicitis rates may be expected in people born since the introduction of improvements in environmental sanitation. Further studies are needed to examine trends in the incidence of appendicitis in populations eating traditional diets with both high and low fibre content and to investigate the significance of changing social and environmental factors.

Abdomen, Acute↗
PubMed2006

Incidence and odds ratio of appendicitis as first manifestation of colon cancer: a retrospective analysis of 1873 patients.

BACKGROUND AND AIM: Obstruction of the lumen of the appendix is the major cause of appendicitis. Tumors could obstruct this lumen and cause appendicitis in the elderly. The association between appendicitis and colon cancer has not been sufficiently investigated, and this study was designed to clarify this association. METHODS: This was a retrospective study. Patients diagnosed with acute appendicitis from January 1998 to December 2003 at the Taipei Veterans General Hospital were surveyed. Patients found to have colon cancers immediately or subsequently after appendectomy were included and analyzed. RESULTS: A total of 1873 patients were diagnosed as having appendicitis of whom 16 were found to have colon cancer. The incidence of appendicitis associated with colon cancer was 0.85%. The time from appendectomy to the recognition of colonic cancer was at a median delay of 5.8 months. From the Taiwan Cancer Research Annual Report, the incidence of colon cancer was 31.91/100,000 in the year 2000. The odds ratio of colon cancer incidence had a 38.5-fold increase among patients older than 40 with acute appendicitis. CONCLUSIONS: In patients over 40 years who present with symptoms of acute appendicitis the possibility of a coexistent colonic neoplasm should always be kept in mind. These patients should undergo colonoscopy 6 weeks after surgery to exclude the possibility of a coexistent colorectal cancer.

Acute Disease↗
PubMed2006

Serosal appendicitis: incidence, causes and clinical significance.

BACKGROUND: Serosal appendicitis is a histopathological diagnosis of an inflammatory reaction on the surface of the appendix caused by an extra appendiceal source of inflammation. OBJECTIVE AND METHODS: A retrospective review of a pathology database in a district general hospital identified patients with serosal appendicitis and a preoperative diagnosis of appendicitis. Two groups emerged: patients with serosal appendicitis secondary to a known cause of intra-abdominal inflammation and those in whom the cause remained unknown. The groups were compared with respect to postoperative complications, referral to outpatient clinics, admissions and procedures by case-note analysis. RESULTS: The incidence of serosal appendicitis was 0.01% (19/1379); 17 women; mean age 31.63 (10.49) years. Lanz incision was used in 16 patients, midline laparotomy in two and laparoscopy in one. A preoperative ultrasound scan was carried out in 5 of 19 patients. The cause of serosal appendicitis was confirmed in eight patients (intraoperatively or postoperatively) and remained unknown in 11 patients. The groups were comparable with respect to age, sex and mean follow-up. No significant difference was observed between them with respect to the above parameters. CONCLUSIONS: No further investigation is necessary in patients who undergo an appendicectomy but in whom the pathological diagnosis is serosal appendicitis. However, considering the patient demographics and the fact that patients with serosal appendicitis have probably undergone an unnecessary appendicectomy, the proportion of patients who underwent ultrasound scanning and diagnostic laparoscopy was small.

Abdominal Pain↗