Jari Mällinen1,2, Siina Vaarala3,4, Markus Mäkinen3,4, Elina Lietzén5,6, Juha Grönroos5,6, Pasi Ohtonen7, Tero Rautio8,7, Paulina Salminen5,6,9. 1. Department of Surgery, Oulu University Hospital, Oulu, Finland. jari.mallinen@gmail.com. 2. Division of Operative Care, Oulu University Hospital and Medical Research Center Oulu, University of Oulu, Oulu, Finland. jari.mallinen@gmail.com. 3. Cancer and Translational Medicine Research Unit, University of Oulu nad Department of Pathology, Oulu University Hospital, Oulu, Finland. 4. Medical Research Center Oulu, Oulu, Finland. 5. Division of Digestive Surgery and Urology, Turku University Hospital, Turku, Finland. 6. Department of Surgery, University of Turku, Turku, Finland. 7. Division of Operative Care, Oulu University Hospital and Medical Research Center Oulu, University of Oulu, Oulu, Finland. 8. Department of Surgery, Oulu University Hospital, Oulu, Finland. 9. Satakunta Central Hospital, Pori, Finland.
Abstract
PURPOSE: Acute appendicitis may present as uncomplicated and complicated and these disease forms differ both epidemiologically and clinically. Complicated acute appendicitis has traditionally been defined as an appendicitis complicated by perforation or a periappendicular abscess, and an appendicolith represents a predisposing factor of complicated disease. There are histopathological differences between uncomplicated acute appendicitis and the previously established traditional forms of complicated acute appendicitis, but to our knowledge, the histopathological differences between uncomplicated acute appendicitis and complicated acute appendicitis presenting with an appendicolith have not yet been reported. The study purpose was to assess these differences with two prospective patient cohorts: (1) computed tomography (CT) confirmed uncomplicated acute appendicitis patients enrolled in the surgical treatment arm of the randomized APPAC trial comparing appendectomy with antibiotics for the treatment of uncomplicated acute appendicitis and (2) patients with CT-verified acute appendicitis presenting with an appendicolith excluded from the APPAC trial. METHODS: The following histopathological parameters were assessed: appendiceal diameter, depth of inflammation, micro-abscesses, density of eosinophils, and neutrophils in appendiceal wall and surface epithelium degeneration. RESULTS: Using multivariable logistic regression models adjusted for age, gender, and symptom duration, statistically significant differences were detected in the depth of inflammation ≤ 2.8 mm (adjusted OR 2.18 (95%CI: 1.29-3.71, p = 0.004), micro-abscesses (adjusted OR 2.16 (95%CI: 1.22-3.83, p = 0.008), the number of eosinophils and neutrophils ≥ 150/mm2 (adjusted OR 0.97 (95%CI: 0.95-0.99, p = 0.013), adjusted OR 3.04 (95%CI: 1.82-5.09, p < 0.001, respectively). CONCLUSIONS: These results corroborate the known clinical association of an appendicolith to complicated acute appendicitis.
RCT Entities:
PURPOSE:Acute appendicitis may present as uncomplicated and complicated and these disease forms differ both epidemiologically and clinically. Complicated acute appendicitis has traditionally been defined as an appendicitis complicated by perforation or a periappendicular abscess, and an appendicolith represents a predisposing factor of complicated disease. There are histopathological differences between uncomplicated acute appendicitis and the previously established traditional forms of complicated acute appendicitis, but to our knowledge, the histopathological differences between uncomplicated acute appendicitis and complicated acute appendicitis presenting with an appendicolith have not yet been reported. The study purpose was to assess these differences with two prospective patient cohorts: (1) computed tomography (CT) confirmed uncomplicated acute appendicitispatients enrolled in the surgical treatment arm of the randomized APPAC trial comparing appendectomy with antibiotics for the treatment of uncomplicated acute appendicitis and (2) patients with CT-verified acute appendicitis presenting with an appendicolith excluded from the APPAC trial. METHODS: The following histopathological parameters were assessed: appendiceal diameter, depth of inflammation, micro-abscesses, density of eosinophils, and neutrophils in appendiceal wall and surface epithelium degeneration. RESULTS: Using multivariable logistic regression models adjusted for age, gender, and symptom duration, statistically significant differences were detected in the depth of inflammation ≤ 2.8 mm (adjusted OR 2.18 (95%CI: 1.29-3.71, p = 0.004), micro-abscesses (adjusted OR 2.16 (95%CI: 1.22-3.83, p = 0.008), the number of eosinophils and neutrophils ≥ 150/mm2 (adjusted OR 0.97 (95%CI: 0.95-0.99, p = 0.013), adjusted OR 3.04 (95%CI: 1.82-5.09, p < 0.001, respectively). CONCLUSIONS: These results corroborate the known clinical association of an appendicolith to complicated acute appendicitis.
Authors: Mikel Prieto; Benedetto Ielpo; Montiel Jiménez Fuertes; María Del Carmen González Sánchez; Esteban Martín Antona; José M Balibrea; José Manuel Aranda Narváez Journal: Cir Esp (Engl Ed) Date: 2020-07-07
Authors: Mikel Prieto; Benedetto Ielpo; Montiel Jiménez Fuertes; María Del Carmen González Sánchez; Esteban Martín Antona; José M Balibrea; José Manuel Aranda Narváez Journal: Cir Esp Date: 2020-07-07 Impact factor: 1.653
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