Retrospective cohort study of the impact of faecoliths on the natural history of acute appendicitis.
Complicated appendicitis
Emergency surgery
Faecolith
Histopathology
Intraoperative
Preoperative CT scan
Journal
World journal of emergency surgery : WJES
ISSN: 1749-7922
Titre abrégé: World J Emerg Surg
Pays: England
ID NLM: 101266603
Informations de publication
Date de publication:
14 03 2023
14 03 2023
Historique:
received:
18
09
2022
accepted:
23
02
2023
entrez:
15
3
2023
pubmed:
16
3
2023
medline:
17
3
2023
Statut:
epublish
Résumé
Despite acute appendicitis is one of the most common surgical emergencies, its aetiology remains incompletely understood. This study aimed to assess the rate at which faecoliths were present in acute appendicitis treated with appendicectomy and whether their presence was associated with complicated appendicitis. All adult patients who underwent appendicectomy for acute appendicitis in a 2 years period (January 2018 and December 2019) at a single institution were retrospectively reviewed. The presence of a faecolith was identified by at least one of three methods: pre-operative CT scan, intraoperative identification, or histopathology report. Patients were grouped according to the presence or absence of a faecolith and demographics, type of appendicitis and surgical outcomes analysed. Complicated appendicitis was defined as appendicitis with perforation, gangrene and/or periappendicular abscess formation. A total of 1035 appendicectomies were performed with acute appendicitis confirmed in 860 (83%), of which 314 (37%) were classified as complicated appendicitis. Three hundred thirty-nine (35%) of the appendicitis cases had faecoliths (complicated 165/314 cases; 53%; uncomplicated 128/546; 23%, p < 0.001). The presence of a faecolith was associated with higher complications and a subsequent longer post-operative stay. The rigorous methodology of this study has demonstrated a higher rate of faecolith presence in acute appendicitis than previously documented. It reinforces the association of faecoliths with a complicated disease course and the importance in prioritising emergency surgery and postoperative monitoring for complications.
Sections du résumé
BACKGROUND
Despite acute appendicitis is one of the most common surgical emergencies, its aetiology remains incompletely understood.
AIM
This study aimed to assess the rate at which faecoliths were present in acute appendicitis treated with appendicectomy and whether their presence was associated with complicated appendicitis.
METHODS
All adult patients who underwent appendicectomy for acute appendicitis in a 2 years period (January 2018 and December 2019) at a single institution were retrospectively reviewed. The presence of a faecolith was identified by at least one of three methods: pre-operative CT scan, intraoperative identification, or histopathology report. Patients were grouped according to the presence or absence of a faecolith and demographics, type of appendicitis and surgical outcomes analysed. Complicated appendicitis was defined as appendicitis with perforation, gangrene and/or periappendicular abscess formation.
RESULTS
A total of 1035 appendicectomies were performed with acute appendicitis confirmed in 860 (83%), of which 314 (37%) were classified as complicated appendicitis. Three hundred thirty-nine (35%) of the appendicitis cases had faecoliths (complicated 165/314 cases; 53%; uncomplicated 128/546; 23%, p < 0.001). The presence of a faecolith was associated with higher complications and a subsequent longer post-operative stay.
CONCLUSION
The rigorous methodology of this study has demonstrated a higher rate of faecolith presence in acute appendicitis than previously documented. It reinforces the association of faecoliths with a complicated disease course and the importance in prioritising emergency surgery and postoperative monitoring for complications.
Identifiants
pubmed: 36918986
doi: 10.1186/s13017-023-00486-8
pii: 10.1186/s13017-023-00486-8
pmc: PMC10012716
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
18Informations de copyright
© 2023. The Author(s).
Références
Surg Endosc. 2020 Jan;34(1):116-125
pubmed: 30919056
BMJ Open Gastroenterol. 2020 Jun;7(1):
pubmed: 32499276
BMJ Open. 2019 Sep 6;9(9):e031137
pubmed: 31494621
World J Emerg Surg. 2020 Apr 15;15(1):27
pubmed: 32295644
Lancet. 2011 May 7;377(9777):1573-9
pubmed: 21550483
Ann R Coll Surg Engl. 2013 Jan;95(1):48-51
pubmed: 23317728
Am J Emerg Med. 1996 Jul;14(4):394-7
pubmed: 8768164
Lancet. 2015 Sep 26;386(10000):1278-1287
pubmed: 26460662
World J Surg. 2021 Jul;45(7):1999-2008
pubmed: 33755751
Infect Dis Clin North Am. 2010 Dec;24(4):995-1018, ix-x
pubmed: 20937462
Gut. 2011 Jan;60(1):34-40
pubmed: 19926616
Future Microbiol. 2019 Jan;14:111-127
pubmed: 30663346
J Surg Res. 2021 Nov;267:477-484
pubmed: 34246841
Can J Surg. 2015 Feb;58(1):10-4
pubmed: 25427333
Emerg Radiol. 2013 Apr;20(2):125-30
pubmed: 23179506
N Engl J Med. 2020 Nov 12;383(20):1907-1919
pubmed: 33017106
Surg Open Sci. 2021 Jun 30;6:1-4
pubmed: 34355156
J Surg Res. 2017 Sep;217:137-143
pubmed: 28599958
Int J Colorectal Dis. 2019 Aug;34(8):1393-1400
pubmed: 31236679
World J Emerg Surg. 2018 Apr 16;13:19
pubmed: 29686725
ANZ J Surg. 2012 Nov;82(11):844-7
pubmed: 22924871