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International Journal of Colorectal Disease

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01-11-2021 | Ultrasound | Review

Classification of acute appendicitis (CAA): treatment directed new classification based on imaging (ultrasound, computed tomography) and pathology

Authors: Jörg C. Hoffmann, Claus-Peter Trimborn, Michael Hoffmann, Ralf Schröder, Sarah Förster, Klaus Dirks, Andrea Tannapfel, Matthias Anthuber, Alois Hollerweger

Published in: International Journal of Colorectal Disease | Issue 11/2021

Abstract

Purpose

Acute appendicitis (AA) is amongst the most common causes of acute abdominal pain. In spite of progress based on risk stratifications, “negative” appendectomies are performed in up to 30% of patients whilst the appendix perforates in others. Preoperative classification of AA based on imaging is therefore recommended. The aim was to classify AA based on imaging (ultrasound/US, computed tomography/CT), surgical pathology, and/or histopathology in order to differentiate between complicated and uncomplicated AA. A new classification of acute appendicitis (CAA) shall be illustrated by typical US and CT images and be employed in a diagnostic and therapeutic algorithm.

Methods

Medline, Embase, and the Cochrane Library were searched. Any study after 1970, which investigated clinical scores, pathology, US, CT, magnetic resonance imaging, and treatment of AA, was included. Typical images were taken from the author’s image database.

Results

Five main types of AA are defined, normal appendix (type 0), nonvisualised appendix (type X), uncomplicated AA (type 1), complicated AA without perforation (type 2), and complicated AA with perforation (type 3). The imaging modality is indicated by an additional letter, e.g., type p3b for free perforation on pathology. Standardised reporting of the appendix evaluation by US and CT is presented, as well as algorithms for AA management. Imaging features indicating imminent perforation, as well as likely recurrence, were both classified as complicated AA.

Conclusion

Imaging is mandatory in suspected AA. The CAA clearly separates uncomplicated from complicated forms of AA allowing nonoperative management in selected patients with uncomplicated forms of AA.

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Title: Classification of acute appendicitis (CAA): treatment directed new classification based on imaging (ultrasound, computed tomography) and pathology
Authors: Jörg C. Hoffmann
Claus-Peter Trimborn
Michael Hoffmann
Ralf Schröder
Sarah Förster
Klaus Dirks
Andrea Tannapfel
Matthias Anthuber
Alois Hollerweger
Publication date: 01-11-2021
Publisher: Springer Berlin Heidelberg
Keywords: Ultrasound
Computed Tomography
Computed Tomography
Appendicitis
Appendicitis
Ultrasound
Pathology
Published in: International Journal of Colorectal Disease / Issue 11/2021
Print ISSN: 0179-1958
Electronic ISSN: 1432-1262
DOI: https://doi.org/10.1007/s00384-021-03940-8

At a glance: The STEP trials

Springer Medicine

Classification of acute appendicitis (CAA): treatment directed new classification based on imaging (ultrasound, computed tomography) and pathology

Abstract

Purpose

Methods

Results

Conclusion

At a glance: The STEP trials

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

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