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International Journal of Colorectal Disease

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Open Access 01-08-2019 | Computed Tomography | Original Article

Appendicolith appendicitis is clinically complicated acute appendicitis—is it histopathologically different from uncomplicated acute appendicitis

Authors: Jari Mällinen, Siina Vaarala, Markus Mäkinen, Elina Lietzén, Juha Grönroos, Pasi Ohtonen, Tero Rautio, Paulina Salminen

Published in: International Journal of Colorectal Disease | Issue 8/2019

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.

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Title: Appendicolith appendicitis is clinically complicated acute appendicitis—is it histopathologically different from uncomplicated acute appendicitis
Authors: Jari Mällinen
Siina Vaarala
Markus Mäkinen
Elina Lietzén
Juha Grönroos
Pasi Ohtonen
Tero Rautio
Paulina Salminen
Publication date: 01-08-2019
Publisher: Springer Berlin Heidelberg
Keywords: Computed Tomography
Computed Tomography
Appendicitis
Appendicitis
Appendectomy
Published in: International Journal of Colorectal Disease / Issue 8/2019
Print ISSN: 0179-1958
Electronic ISSN: 1432-1262
DOI: https://doi.org/10.1007/s00384-019-03332-z

At a glance: The STEP trials

Springer Medicine

Appendicolith appendicitis is clinically complicated acute appendicitis—is it histopathologically different from uncomplicated acute appendicitis

Abstract

Purpose

Methods

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

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