![]() This study retrospectively reviewed all appendectomies performed between January 2018 and December 2019 at Christchurch Hospital, Canterbury, New Zealand. In this study, we used the above methodology to assess the rate at which faecoliths were present in acute appendicitis treated with appendicectomy, and whether the presence of faecoliths was associated with complicated appendicitis. There is to date, however, no published study that assesses the presence of faecoliths using methodology inclusive of pre-operative imaging, intra-operative findings, and histology the composite of which may well give a more complete appraisal of their role. Several of these studies have correlated the size and location of faecoliths in relation to the severity of appendicitis, while other studies have assessed histopathological parameters, comparing uncomplicated and complicated appendicitis. However, most of the studies utilised abdominal CT scans to assess the presence of faecoliths. Previous studies including large international study have demonstrated the significance of faecoliths in acute appendicitis and its associated complications. Seasonal variations have also been shown to affect the incidence of acute appendicitis in several studies, with the highest incidence of acute appendicitis seen in spring and summer months. Organisms including Escherichia coli, Klebsiella pneumoniae, Streptococcus spp, Enterococcus and Pseudomonas aeruginosa have all been detected by culture suggesting a possible causative relationship and ongoing microbiome studies are investigating the role of microbiota dysbiosis leading to acute appendicitis. Invasive pathogens such as Fusobacteria were found to have a positive correlation to the severity of acute appendicitis. In addition to luminal obstruction, other potential primary causes of appendicitis have been implicated including viral and bacterial. Multiple studies showed that luminal obstruction-associated appendicitis may have a varied aetiology such as faecoliths, pinworms, lymphoid hyperplasia, foreign bodies, amebiasis, tuberculosis, endometriosis or tumour in patients presenting with clinical appendicitis. ĭirect luminal obstruction is thought to be a contributor to the aetiology of acute appendicitis. Despite its frequency, the aetiology remains incompletely understood. The healthcare burden for acute appendicitis is significant, with a high mean hospital cost and consequential national annual expenditure. It is most prevalent in the 15–19 years age group. It reinforces the association of faecoliths with a complicated disease course and the importance in prioritising emergency surgery and postoperative monitoring for complications.Īcute appendicitis is a common surgical emergency, affecting 17.7 million people annually worldwide. The rigorous methodology of this study has demonstrated a higher rate of faecolith presence in acute appendicitis than previously documented. The presence of a faecolith was associated with higher complications and a subsequent longer post-operative stay. Three hundred thirty-nine (35%) of the appendicitis cases had faecoliths (complicated 165/314 cases 53% uncomplicated 128/546 23%, p < 0.001). Complicated appendicitis was defined as appendicitis with perforation, gangrene and/or periappendicular abscess formation.Ī total of 1035 appendicectomies were performed with acute appendicitis confirmed in 860 (83%), of which 314 (37%) were classified as complicated appendicitis. Patients were grouped according to the presence or absence of a faecolith and demographics, type of appendicitis and surgical outcomes analysed. The presence of a faecolith was identified by at least one of three methods: pre-operative CT scan, intraoperative identification, or histopathology report. MethodsĪll adult patients who underwent appendicectomy for acute appendicitis in a 2 years period (January 2018 and December 2019) at a single institution were retrospectively reviewed. This study aimed to assess the rate at which faecoliths were present in acute appendicitis treated with appendicectomy and whether their presence was associated with complicated appendicitis. Despite acute appendicitis is one of the most common surgical emergencies, its aetiology remains incompletely understood.
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