Eleonora Guaitoli1, Gaetano Gallo2, Eleonora Cardone3, Luigi Conti4, Simone Famularo5, Giampaolo Formisano6, Federica Galli7, Giuseppe Giuliani6, Antonio Martino8, Alessandro Pasculli9, Romeo Patini10, Domenico Soriero8, Vincenzo Pappalardo11, Gianmaria Casoni Pattacini8, Marco Sparavigna8, Roberto Meniconi12, Andrea Mazzari13, Fabio Barra14,15, Elena Orsenigo16, Davide Pertile8. 1. Department of Surgery, A. Perrino Hospital, Brindisi, Italy. 2. Department of Medical and Surgical Sciences, University of Catanzaro, Catanzaro, Italy. 3. Department of Surgery, Santa Maria del Popolo degli Incurabili Hospital, Napoli, Italy. 4. Department of Surgery, G. Da Saliceto Hospital, Piacenza, Italy. 5. Department of Medicine and Surgery University of Milan Bicocca HPB Unit, San Gerardo Hospital, Monza, Italy. 6. Department of General and Minimally Invasive Surgery, Misericordia Hospital, Grosseto, Italy. 7. General Surgery, University of Insubria, Varese, Italy. 8. Department of General Surgery, University of Genoa, Genova, Italy. 9. Department V. Bonomo, General Surgery, University of Bari, Bari, Italy. 10. Odontostomatology and Oral Surgery, Sacro Cuore Hospital, Rome, Italy. 11. General Surgery, Circolo Fondazione Macchi Hospital, Varese, Italy. 12. Department of General Surgeon and Transplantations, San Camillo-Forlanini Hospital, Rome, Italy. 13. Mini Invasive and General Surgery, Cristo Re Hospital, Rome, Italy. 14. Academic Unit of Obstetrics and Gynaecology, IRCCS Ospedale Policlinico San Martino, Genova, Italy. 15. Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI), University of Genova, Genova, Italy. 16. Department of General and Emergency Surgery, San Raffaele Scientific Institute, Milano, Italy.
Abstract
BACKGROUND: Acute appendicitis (AA) is one of the most common causes of abdominal pain requiring surgical intervention. Approximately 20% of AA cases are characterized by complications such as gangrene, abscesses, perforation, or diffuse peritonitis, which increase patients' morbidity and mortality. Diagnosis of AA can be difficult, and evaluation of clinical signs, laboratory index and imaging should be part of the management of patients with suspicion of AA. METHODS: This consensus statement was written in relation to the most recent evidence for diagnosis and treatment of AA, performing a literature review on the most largely adopted scientific sources. The members of the SPIGC (Italian Polispecialistic Society of Young Surgeons) worked jointly to draft it. The recommendations were defined and graded based on the current levels of evidence and in accordance with the criteria adopted by the American College of Chest Physicians (CHEST) for the strength of the recommendations. RESULTS: Fever and migratory pain tend to be present in patients with suspicion of AA. Laboratory and radiological examinations are commonly employed in the clinical practice, but today also scoring systems based on clinical signs and laboratory data have slowly been adopted for diagnostic purpose. The clinical presentation of AA in children, pregnant and elderly patients can be unusual, leading to more difficult and delayed diagnosis. Surgery is the best option in case of complicated AA, whereas it is not mandatory in case of uncomplicated AA. Laparoscopic surgical treatment is feasible and recommended. Postoperative antibiotic treatment is recommended only in patients with complicated AA.
BACKGROUND: Acute appendicitis (AA) is one of the most common causes of abdominal pain requiring surgical intervention. Approximately 20% of AA cases are characterized by complications such as gangrene, abscesses, perforation, or diffuse peritonitis, which increase patients' morbidity and mortality. Diagnosis of AA can be difficult, and evaluation of clinical signs, laboratory index and imaging should be part of the management of patients with suspicion of AA. METHODS: This consensus statement was written in relation to the most recent evidence for diagnosis and treatment of AA, performing a literature review on the most largely adopted scientific sources. The members of the SPIGC (Italian Polispecialistic Society of Young Surgeons) worked jointly to draft it. The recommendations were defined and graded based on the current levels of evidence and in accordance with the criteria adopted by the American College of Chest Physicians (CHEST) for the strength of the recommendations. RESULTS: Fever and migratory pain tend to be present in patients with suspicion of AA. Laboratory and radiological examinations are commonly employed in the clinical practice, but today also scoring systems based on clinical signs and laboratory data have slowly been adopted for diagnostic purpose. The clinical presentation of AA in children, pregnant and elderly patients can be unusual, leading to more difficult and delayed diagnosis. Surgery is the best option in case of complicated AA, whereas it is not mandatory in case of uncomplicated AA. Laparoscopic surgical treatment is feasible and recommended. Postoperative antibiotic treatment is recommended only in patients with complicated AA.