OBJECTIVE: Unperforated and perforated acute appendicitis need to be differentiated because appendicitis with a free perforation requires an emergency operation to prevent contamination inside the bowel from spreading into the peritoneal cavity. The sensitivity of imaging tests is not reliable enough alone for determining the existence of a perforation. The aim of this study was to determine the differences in laboratory values between unperforated and perforated acute appendicitis to help distinguish perforated acute appendicitis. METHODS: The laboratory values and demographic data of a total of 175 patients who visited the emergency room and were diagnosed with acute appendicitis were collected. The time elapsed from symptom presentation to the ER visit, length of admission, patient demographics, and laboratory values, including sex, age, leukocyte count, neutrophil %, neutrophil count, C-reactive protein (CRP), platelet count, prothrombin time (PT), activated partial thromboplastin time, international normalized ratio (INR), serum glucose, blood urea nitrogen, creatinine, total and direct bilirubin, aspartate aminotransferase, alanine aminotransferase, alkaline phosphatase, and gamma-glutamyltransferase were analyzed. RESULTS: The factors associated with appendix perforations were an elevated leukocyte count, neutrophil count, neutrophil %, CRP, serum glucose and total bilirubin; and delayed PT and INR. CONCLUSION: Acute appendicitis patients without definite imaging evidence of the perforation but with the laboratory values suggesting a perforation, such as elevated leukocyte count, neutrophil count, neutrophil %, CRP, serum glucose, and total bilirubin; and delayed PT, and INR should raise concern for a possible undiscovered perforation.
Abdomen, Acute ; Alanine Transaminase ; Alkaline Phosphatase ; Appendicitis ; Appendix ; Aspartate Aminotransferases ; Bilirubin ; Blood Glucose ; Blood Urea Nitrogen ; C-Reactive Protein ; Creatinine ; Demography ; Diagnosis, Differential ; Emergencies ; Emergency Service, Hospital ; gamma-Glutamyltransferase ; Humans ; International Normalized Ratio ; Leukocyte Count ; Neutrophils ; Partial Thromboplastin Time ; Patient Admission ; Peritoneal Cavity ; Platelet Count ; Prothrombin Time

PURPOSE: To investigate the predictors of perforated appendicitis (PA) in pediatric patients with appendicitis seen in the emergency department. METHODS: We retrospectively reviewed 564 pediatric patients (< 16 years) who visited the emergency department and subsequently had pathologically confirmed appendicitis from 2005 through 2014. Clinical features, inflammatory markers, including the white blood cell (WBC), neutrophil, and lymphocyte counts, neutrophil-to-lymphocyte ratio, C-reactive protein (CRP) concentration, erythrocyte sedimentation rate (ESR), and the Alvarado score were compared between the patients with and without PA regarding their predictability of PA. RESULTS: Of 564 pediatric patients with appendicitis, 204 (36.2%) had PAs. The patients with PA had longer duration of symptoms and median length of hospital stay, more frequent nausea and vomiting, and higher median WBC and neutrophil counts, neutrophil-to-lymphocyte ratio, ESR, and CRP concentration. Overall, WBC count showed the highest sensitivity of 79.9% and negative predictive value of 82.6%, and CRP concentration had the highest area under the receiver operating characteristic curve of 0.72. Multivariable logistic analysis showed that WBC count > 13.5 × 109/L (odds ratio [OR], 3.27; confidence interval [CI], 1.49–7.18; P = 0.003) and ESR > 15 mm/h (OR, 3.18; 95% CI, 2.13–4.74; P < 0.001) are independent predictors of PA. CONCLUSION: WBC count and ESR might be better predictors of PA in pediatric patients with appendicitis in the emergency department than the Alvarado score and CRP concentration.
Appendicitis* ; Blood Sedimentation ; C-Reactive Protein ; Child* ; Emergencies ; Emergency Service, Hospital ; Humans ; Length of Stay ; Leukocyte Count* ; Leukocytes* ; Lymphocyte Count ; Nausea ; Neutrophils ; Pediatrics ; Prognosis ; Retrospective Studies ; ROC Curve ; Vomiting

BACKGROUND/AIMS: Familial Mediterranean fever (FMF) is an autosomal recessive disorder characterized by attacks of fever and diffuse abdominal pain. The primary concern with this presentation is to distinguish it from acute appendicitis promptly. Thus, we aimed to evaluate the role of neutrophil lymphocyte ratio (NLR) to leverage the differential diagnosis of acute FMF attack with histologically proven appendicitis. METHODS: Twenty-three patients with histologically confirmed acute appendicitis and 88 patients with acute attack of FMF were included in the study. NLR, C-reactive protein and other hematologic parameters were compared between the groups. RESULTS: Neutrophil to lymphocyte ratio was significantly higher in patients with acute appendicitis compared to the FMF attack group (8.24 +/- 6.31 vs. 4.16 +/- 2.44, p = 0.007). The performance of NLR in diagnosing acute appendicitis with receiver operating characteristic analysis with a cut-off value of 4.03 were; 78% sensitivity, 62% specificity, and area under the curve 0.760 (95% confidence interval, 0.655 to 0.8655; p < 0.001). CONCLUSIONS: This study showed that NLR, the simple and readily available inflammatory marker may have a useful role in distinguishing acute FMF attack from acute appendicitis.
Adult ; Appendicitis/blood/*diagnosis ; Area Under Curve ; Biomarkers/blood ; Blood Sedimentation ; Diagnosis, Differential ; Familial Mediterranean Fever/blood/*diagnosis ; Female ; Humans ; Inflammation Mediators/blood ; Lymphocyte Count ; *Lymphocytes ; Male ; *Neutrophils ; Platelet Count ; Predictive Value of Tests ; ROC Curve ; Reproducibility of Results ; Retrospective Studies ; Young Adult

OBJECTIVETo explore the clinical application of laparoscopy in gastrointestinal abdominal emergency operation for patients over 65 years old.

METHODSClinical data of 138 cases (age>65 years) with acute abdomen undergoing laparoscopic surgery from January 2006 to June 2014 were analyzed retrospectively. Data of 170 cases treated by laparotomy during the same period were enrolled as controls.

RESULTSThe laparoscopy group and the laparotomy group showed statistically significant differences in blood loss [(107.1±47.7) ml vs. (163.6±106.5) ml, P=0.000], postoperative complications rate [2.9%(4/138) vs. 12.9%(22/170), P=0.022], hospital stay [(10.5±7.5) d vs. (16.5±9.9) d, P=0.044], postoperative ambulation time [(25.6±7.7) h vs. (33.2±5.6) h, P=0.020], and recovery time of postoperative gastrointestinal function [(36.9±9.1) h vs. (49.3±10.6) h, P=0.031]. Patients with acute appendicitis, upper digestive tract perforation and bowel obstruction in the laparoscopy group were superior to those in the laparotomy group in hospital stay, postoperative ambulation time, recovery time of postoperative gastrointestinal function and intraoperative blood loss(all P<0.01), while no significant differences in colon perforation and mesentery diseases were found in hospital stay, intraoperative blood loss and recovery time of postoperative gastrointestinal function between the two groups (all P>0.05).

CONCLUSIONSCompared with laparotomy, the laparoscopy offers the advantages of less trauma, faster recovery, shorter hospital stay, and lower postoperative complications rate for patients over 65 years with acute abdomen.

Abdomen, Acute ; Acute Disease ; Aged ; Appendicitis ; Blood Loss, Surgical ; Digestive System Surgical Procedures ; Humans ; Intestinal Obstruction ; Intestinal Perforation ; Laparoscopy ; Laparotomy ; Length of Stay ; Postoperative Complications ; Postoperative Period ; Retrospective Studies

OBJECTIVETo evaluate the value of high mobility group box 1(HMGB1) in the diagnosis of pediatric acute appendicitis.

METHODSThe children with acute abdomen who had a diagnosis of suspected acute appendicitis between January and July 2013 and 25 healthy children were enrolled in this study. Serum HMGB1 levels were measured using ELISA on admission. The patients were classified into 2 groups according to surgery confirmation or pathological results: appendicitis (n=28) and non-appendicitis (n=35).

RESULTSSerum HMGB1 levels and WBC in the appendicitis and non-appendicitis groups were significantly higher than in the healthy children group (P<0.01). The appendicitis group showed more increased serum HMGB1 levels compared with the non-appendicitis group (median: 32.9 ng/mL vs 22.0 ng/mL; P<0.01). For a diagnosis of acute appendicitis, the sensitivity and specificity of serum HMGB1 was 71.4% and 82.9% respectively at the best cutoff of 28.0 ng/mL, with the accuracy of 77.8% and the area under the curve of 0.765 (95%CI 0.638-0.893).

CONCLUSIONSHMGB1 may play a role in the diagnosis of pediatric acute appendicitis.

Acute Disease ; Appendicitis ; blood ; diagnosis ; Child, Preschool ; Female ; HMGB1 Protein ; blood ; Humans ; Infant ; Male

Omental torsion is a rare cause of acute abdominal pain. It presents with nonspecific symptoms and signs of an acute abdomen, making it difficult to diagnose preoperatively, because symptoms mimic those caused by other conditions such as appendicitis, cholecystitis, diverticulitis, and other gynecologic diseases. Computed tomography is an effective and useful method to diagnose and exclude other acute abdominal conditions. Our case presented with sudden right upper abdominal pain with tenderness, rebound tenderness, mild fever (37.2degrees C), increased erythrocyte sedimentation rate (37 mm/hr), increased high-sensitivity C-reactive protein level (5.97 mg/dL). Computed tomography showed a large, well-circumscribed heterogeneous fatty mass and a 7.3 cm subserosal myoma. We could not exclude the myoma as the cause of acute abdominal pain, so we performed an emergency operation with suspicion of omental torsion or necrotic degeneration of the myoma. During the operation, we diagnosed primary omental torsion with infarction and subserosal myoma without secondary degeneration.
Abdomen, Acute ; Abdominal Pain ; Appendicitis ; Blood Sedimentation ; C-Reactive Protein ; Cholecystitis ; Diverticulitis ; Emergencies ; Female ; Fever ; Genital Diseases, Female ; Hysterectomy* ; Infarction ; Myoma

PURPOSE: The delta neutrophil index corresponds to calculated immature granulocyte counts and severity of sepsis. This study was conducted in order to investigate the diagnostic value of the delta neutrophil index as a preoperative laboratory marker for appendiceal perforation in patients with acute appendicitis. METHODS: This study was conducted as a retrospective analysis of patients confirmed pathologically as appendicitis at two hospitals from November 2009 to September 2010. Delta neutrophil index was automatically calculated as a subset of routine complete blood count testing. The diagnostic performance of the delta neutrophil index for perforated appendicitis was evaluated. RESULTS: During the study period, 308 patients were enrolled. Among them, 32 patients (10.4%) were confirmed as perforated appendicitis. The delta neutrophil index was significantly higher in the perforated group, compared with the non-perforated group (4.8+/-7.1% vs 2.0+/-2.0%, p<0.05). Sensitivity and specificity of the delta neutrophil index for prediction of perforated appendicitis was 25.0% and 96.7%, respectively, at a cutoff level of 5% with an area under the curve of 0.78 on the ROC (receiver operating characteristics) curve. CONCLUSION: Results of this study suggested an association of the delta neutrophil index with perforated appendicitis. However, the sensitivity was not high enough for use as clinical guidance.
Appendicitis ; Biomarkers ; Blood Cell Count ; Granulocytes ; Humans ; Neutrophils ; Retrospective Studies ; Sensitivity and Specificity ; Sepsis

OBJECTIVETo investigate the value of serum inflammatory markers in the diagnosis of acute appendicitis (AA) in children.

METHODSBlood samples were collected from 51 children with AA and 16 children with nonsurgical abdominal pain (NSAP) to examine white blood cell count (WBC), serum C-reactive protein (CRP), interleukin-6, and tumor necrosis factor-α (TNF-α).

RESULTSWBC count, CRP, IL-6 and TNF-α increased significantly in children with severe AA (phlegmonous or gangrenous, and perforated appendicitis). ROC curves showed that IL-6 or TNF-α had a greater contribution than WBC count to the diagnosis of severe appendicitis.

CONCLUSIONIL-6 and TNF-α can provide complementary information to assist the clinical decision of emergency operation for children with AA.

Appendicitis ; blood ; diagnosis ; Biomarkers ; blood ; C-Reactive Protein ; metabolism ; Child ; Child, Preschool ; Female ; Humans ; Inflammation ; blood ; diagnosis ; Interleukin-6 ; blood ; Lymphocyte Count ; Male ; Tumor Necrosis Factor-alpha ; blood

BACKGROUND/AIMS: Clinical manifestations of intestinal yersiniosis include enterocolitis, mesenteric adenitis, and terminal ileitis presenting with fever, right lower quadrant pain, and leukocytosis. According to a previous Korean study in 1997, Yersinia was revealed in two among 15 adult patients with mesenteric adenitis (13%). However, recent reports on the prevalence of Yersinia infection in adult patients are few. The aim of this study was to investigate the prevalence of Yersinia infection in adult patients with acute right lower quadrant pain. METHODS: Adult patients (>18 years) who visited Eulji medical center, due to acute right lower quadrant pain were enrolled prospectively from December 2007 to July 2009. Abdominal CT, stool culture, serologic test for Yersinia, and Widal test were performed. RESULTS: Among 115 patients, 5 patients were excluded due to positive Widal test or salmonella culture. In 110 patients, abdominal CT showed right colitis in 20 (18.2%), terminal ileitis in 16 (14.5%), mesenteric adenitis in 13 (11.8%), acute appendicitis in 10 (9.1%), acute diverticulitis in 7 (6.4%), non specific mucosal edema in 36 (32.7%) and no specific lesion in 8 (7.3%). Two (1.8%) of the 110 patients had antibodies to Yersinia. One patient showed acute enteritis and the other patient was diagnosed with acute appendicitis and underwent appendectomy. No Yersinia species were grown on stool or tissue culture. CONCLUSIONS: Nowadays, among adult Korean patients presenting with acute right lower quadrant pain, there have been few incidences of Yersinia infection.
Abdominal Pain/*microbiology ; Acute Disease ; Adult ; Aged ; Aged, 80 and over ; Antibodies/blood/immunology ; Appendicitis/epidemiology ; Colitis/epidemiology ; Diverticulitis/epidemiology ; Edema/epidemiology ; Female ; Humans ; Ileitis/epidemiology ; Lymphadenitis/epidemiology ; Male ; Middle Aged ; Prevalence ; Prospective Studies ; Tomography, X-Ray Computed ; Yersinia/*isolation & purification ; Yersinia Infections/*diagnosis/*epidemiology

Acute appendicitis is the most frequent cause of acute abdomen. However, bacteremia in patient with acute appendicitis is rare. A 34-year-old male patient presenting with fever and abdominal discomfort for two days showed leukocytosis, elevated C-reactive protein and erythrocyte sedimentation rate. Gram-negative rods were cultured in blood and empirical ceftriaxone was injected intravenously. On abdominal CT, wall enhanced and distended retrocecal appendix was recognized. Appendectomy was performed, which revealed suppurative inflammation without perforation. We report a case of acute appendicitis without perforation associated with Escherichia coli sepsis and atypical clinical manifestations in a healthy male.
Abdomen, Acute ; Adult ; Appendectomy ; Appendicitis ; Appendix ; Bacteremia ; Blood Sedimentation ; C-Reactive Protein ; Ceftriaxone ; Escherichia ; Escherichia coli ; Fever ; Humans ; Inflammation ; Leukocytosis ; Male ; Sepsis