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Diagnostics
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Appendicitis: Diagnosis and Management
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Appendicitis: Diagnosis and Management

A special issue of Diagnostics (ISSN 2075-4418). This special issue belongs to the section "Pathology and Molecular Diagnostics".

Deadline for manuscript submissions: closed (31 May 2022) | Viewed by 7081

Special Issue Editors

Prof. Dr. Marja A. Boermeester

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Guest Editor
Department of Surgery, Academisch Medisch Centrum Universiteit van Amsterdam | AMC, Amsterdam, The Netherlands
Interests: acute abdomen; surgical infections such as appendicitis or diverticulitis; intestinal failure surgery; complex abdominal wall repair
Dr. Jochem C.G. Scheijmans

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Guest Editor
Department of Surgery, Amsterdam University Medical Centers, location AMC, University of Amsterdam, Amsterdam, The Netherlands
Interests: acute abdomen; surgical infections such as appendicitis
Dr. Wouter J. Bom

E-Mail Website
Guest Editor
1. Department of Surgery, Tergooi Hospital, Hilversum, The Netherlands
2. Department of Surgery, Amsterdam University Medical Centers, location AMC, University of Amsterdam, Amsterdam, The Netherlands
Interests: acute abdomen; surgical infections such as appendicitis

Special Issue Information

Dear Colleagues,

Appendicitis is the most common infectious disease in the abdomen. With a lifetime risk of almost 1 in 11 persons, appendicitis has been diagnosed in innumerable patients worldwide. Nevertheless, there is much to learn about diagnostics and management, with guidelines varying in their advice. Nonoperative treatment for simple appendicitis is safe, but has different risks and benefits than regular appendectomy. Therefore, a patients’ preference becomes more important.

This Special Issue focuses on the challenges and recent advances in diagnosis (laboratory markers, imaging, differential diagnosis), management (surgery vs. antibiotics, laparoscopy vs. open, NOTES, choice and duration of antibiotics, pathology), and associated complications (e.g., perforation, abscess, wound infection, bowel obstruction, incisional hernia, recurrent appendicitis).

Of particular interest is the influence of various characteristics of the inflamed appendix (e.g., fecolith, diameter, periappendicular fluid, suspicion of perforation) and of the patient (e.g., age, comorbidity) on the identification of complicated appendicitis, treatment decisions, timing, and outcome. Articles on innovations in diagnostics or on the etiology of complicated appendicitis are encouraged.

Authors can submit original articles, reviews, or short communications. We welcome submissions from clinical, translational, and basic research.

Prof. Dr. Marja A. Boermeester
Dr. Jochem C.G. Scheijmans
Dr. Wouter J. Bom
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Diagnostics is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • appendicitis
  • uncomplicated
  • perforated
  • appendectomy
  • antibiotics
  • diagnostic imaging
  • inflammatory markers
  • complications
  • pathology
  • differential diagnosis

Published Papers (3 papers)

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Research

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10 pages, 3984 KiB  
Article
Daytime versus Nighttime in Acute Appendicitis
by Wouter J. Bom, Joske de Jonge, Jochem C. G. Scheijmans, Anna A. W. van Geloven, Sarah L. Gans, Marja A. Boermeester, Willem A. Bemelman, Charles C. van Rossem and on behalf of the SNAPSHOT
Diagnostics 2022, 12(4), 788; https://0-doi-org.brum.beds.ac.uk/10.3390/diagnostics12040788 - 23 Mar 2022
Cited by 2 | Viewed by 1559
Abstract
Background: Little is known about patients with appendicitis presenting at nighttime. It is hypothesized that patients presented at night more frequently have a complicated (gangrenous or perforated) appendicitis and therefore develop more postoperative complications. Methods: In this study data were used from the [...] Read more.
Background: Little is known about patients with appendicitis presenting at nighttime. It is hypothesized that patients presented at night more frequently have a complicated (gangrenous or perforated) appendicitis and therefore develop more postoperative complications. Methods: In this study data were used from the nationwide, prospective SNAPSHOT study appendicitis, including 1975 patients undergoing surgery for suspected appendicitis. This study included only adults. Two primary outcomes were defined: (A) The proportion of patients with complicated appendicitis and (B) the proportion of patients with a complication postoperatively presenting during daytime versus nighttime period. Analysis for both complicated and uncomplicated appendicitis was performed, and a multivariate model was used to correct for baseline characteristics and time to surgery. Results: In total, 1361 adult patients with appendicitis were analyzed. Both at nighttime and at daytime, 34% had complicated appendicitis. In patients presenting in the daytime, 12.1% developed a postoperative complication versus 18.6% for presentation at night (p = 0.008). In a multivariate analysis, the risk for a postoperative complication when presenting at night was significantly increased (adjusted OR 1.74; 95% CI 1.14–2.66, p = 0.01). Surgery within eight hours after presentation does not lower this risk (adjusted OR 1.37; 95% CI 0.97–1.95, p = 0.078). Conclusion: Complicated appendicitis is seen as frequently during the day as at nighttime. For patients who present at nighttime with acute appendicitis, the risk of a postoperative complication is higher compared with a presentation at daytime. In multivariate analysis, nighttime presentation but not surgery within 8 h after presentation is independently associated with postoperative complication risk. Full article
(This article belongs to the Special Issue Appendicitis: Diagnosis and Management)
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Review

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8 pages, 407 KiB  
Review
The Diagnostic Differentiation Challenge in Acute Appendicitis: How to Distinguish between Uncomplicated and Complicated Appendicitis in Adults
by Benedicte Skjold-Ødegaard and Kjetil Søreide
Diagnostics 2022, 12(7), 1724; https://0-doi-org.brum.beds.ac.uk/10.3390/diagnostics12071724 - 15 Jul 2022
Cited by 9 | Viewed by 3312
Abstract
(1) Background: How to best define, diagnose and differentiate uncomplicated from complicated acute appendicitis remains debated. Hence, the aim of this review was to present an overview of the current knowledge and emerging field of acute appendicitis with a focus on the diagnostic [...] Read more.
(1) Background: How to best define, diagnose and differentiate uncomplicated from complicated acute appendicitis remains debated. Hence, the aim of this review was to present an overview of the current knowledge and emerging field of acute appendicitis with a focus on the diagnostic differentiation of severity currently subject to ongoing investigations. (2) Methods: We conducted a PubMed search using the MeSH terms “appendicitis AND severity” and “appendicitis AND classification”, with a focus on studies calling appendicitis as ‘uncomplicated’ or ‘complicated’. An emphasis on the last 5 years was stressed, with further studies selected for their contribution to the theme. Further studies were retrieved from identified full-text articles and included per the authors’ discretion. (3) Results: The assumption that appendicitis invariably will proceed to perforation has been outdated. Both uncomplicated and complicated appendicitis exist with likely different pathophysiology. Hence, this makes it important to differentiate disease severity. Clinicians must diagnose appendicitis, but, in the next step, also differentiate between uncomplicated and complicated appendicitis in order to allow for management decisions. Diagnostic accuracy without supportive imaging is around 75–80% and, based on clinical judgement and blood tests alone, the negative appendectomy rate has been described as high as 36%. More research is needed on available biomarkers, and the routine use of imaging still remains debated. Scoring systems have the potential to improve diagnostic accuracy, but no scoring system has yet been validated for differentiating disease severity. Currently, no universally agreed definition exists on what constitutes a complicated appendicitis. (4) Conclusions: Uncomplicated and complicated appendicitis appear to have different pathophysiology and should be treated differently. The differentiation between uncomplicated and complicated appendicitis remains a diagnostic challenge. Full article
(This article belongs to the Special Issue Appendicitis: Diagnosis and Management)
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Other

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12 pages, 1464 KiB  
Systematic Review
Mean Platelet Volume in the Diagnosis of Acute Appendicitis in the Pediatric Population: A Systematic Review and Meta-Analysis
by Nellai Krishnan, Sachit Anand, Niklas Pakkasjärvi, Minu Bajpai, Anjan Kumar Dhua and Devendra Kumar Yadav
Diagnostics 2022, 12(7), 1596; https://0-doi-org.brum.beds.ac.uk/10.3390/diagnostics12071596 - 30 Jun 2022
Cited by 3 | Viewed by 1686
Abstract
Background: Mean Platelet Volume (MPV) has been suggested as a biomarker for acute appendicitis (AA) in the adult population. The utility of MPV in pediatric AA remains vague. This systematic review and meta-analysis aimed to systematically summarize and compare all relevant data on [...] Read more.
Background: Mean Platelet Volume (MPV) has been suggested as a biomarker for acute appendicitis (AA) in the adult population. The utility of MPV in pediatric AA remains vague. This systematic review and meta-analysis aimed to systematically summarize and compare all relevant data on MPV as a diagnostic biomarker for AA in children. Methods: Databases were systematically searched using keywords ((mean platelet volume) OR mpv) AND (appendicitis). The inclusion criteria were all comparative studies of MPV in children aged less than 18 years and diagnosed with AA. Two authors independently assessed the methodological quality using the Downs and Black scale. Results: We included fourteen studies in the final meta-analysis; most were retrospective. Eight studies compared the MPV values between AA and non-AA; four studies compared the same between AA and healthy controls; two studies compared the MPV values among all three groups. The estimated heterogeneity among the studies for all outcomes was high and statistically significant. The pooling the data showed no statistically significant difference in MPV (weighted mean difference (WMD) = −0.42, 95% CI = (−1.04, 0.20), p = 0.19) between AA and healthy controls or AA and non-AA cases (WMD = 0.01, 95% CI = (−0.15, 0.17), p = 0.90). Conclusion: While MPV levels seem to have some utility in adult AA diagnosis, MPV levels should not dictate treatment options in pediatric AA. Full article
(This article belongs to the Special Issue Appendicitis: Diagnosis and Management)
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