To analyze the clinical characteristics and perforation predictors of appendicitis in infants and toddlers younger than 3 years of age. A retrospective analysis was conducted on the children under 3 years old diagnosed with appendicitis and treated at two centers between March 2018 and May 2024. Based on pathological findings, patients were divided into perforated and non-perforated groups. Further classification was based on the presence or absence of post-appendectomy abscess, resulting in three groups: non-perforated, perforated with post-appendectomy abscess, and perforated without post-appendectomy abscess. Among 72 children with appendicitis, 45 were male (62.5%) and 27 were female (37.5%), with a median age of 31.0 (IQR, 27.0-34.0) months and an average weight of 13.7 ± 2.7 kg. Abdominal ultrasound had a positivity rate of 69.4% (50/72), and 22 patients underwent additional CT scans. All cases were treated with laparoscopic appendectomy, without conversions to open surgery. Perforated appendicitis was diagnosed in 58 cases (80.6%), and non-perforated appendicitis in 14 cases (19.4%). The median symptom duration (48.0 vs. 21.0 h; p < 0.01), CRP levels (70.5 vs. 22.0 mg/L; p < 0.05), and incidence of appendicoliths were significantly higher in the perforated group (p < 0.05). Post-appendectomy abscess was the most common complication, with appendicoliths and prolonged symptom duration being significant risk factors (p < 0.05). The perforated group with post-appendectomy abscess had a significantly longer median hospital stay than the non-perforated group (12.0 vs. 6.0 days; p < 0.01). ROC analysis identified CRP (AUC 0.69, cutoff 34.5 mg/L; p < 0.05) and symptom duration (AUC 0.74, cutoff 35 h; p < 0.01) as predictors of perforation. The high perforation rate of appendicitis in infants and toddlers is associated with prolonged symptoms, elevated CRP, and appendicoliths. Extended symptom duration and appendicoliths increase the risk of post-appendectomy abscesses.

Acute appendicitis with an appendicolith is one of the most common abdominal emergencies in elderly patients and is more likely to progress to gangrene and perforation.

To analyze the clinical data of elderly patients undergoing emergency appendectomy for acute appendicitis, aiming to improve treatment strategies.

The clinical data of 122 patients over 80 years old who underwent emergency appendectomy for acute appendicitis at the Department of Emergency Surgery of Zhongshan Hospital, Fudan University from January 2016 to March 2023 were retrospectively analyzed. The patients were divided into two groups based on the presence of an appendicolith or not, and clinicopathological and surgery-related features were compared between the two groups.

The duration of abdominal pain in all 122 patients ranged from 5 to 168 h. All patients underwent emergency appendectomy: 6 had an open appendectomy, 101 had a laparoscopic appendectomy, and 15 required conversion from laparoscopic to open surgery, resulting in a conversion rate of 12.9% (15/116). The patients were divided into two groups: Appendicolith group (n = 46) and non-appendicolith group (n = 76). Comparisons of clinicopathological features revealed that patients with appendicoliths were more likely to develop appendiceal gangrene (84.8% vs 64.5%, P = 0.010) and perforation (67.4% vs 48.7%, P = 0.044), and had a lower surgical conversion rate (2.2% vs 19.7%, P = 0.013). The median length of hospital stay was 5.0 d for both groups and there was no significant difference between them. All patients were successfully discharged.

Around 40% of patients over 80 years old with acute appendicitis have an appendicolith, increasing their risk of developing appendiceal gangrene and perforation, and therefore should receive timely surgical treatment.

Appendicolith causes acute appendicitis. However, surgical indications for appendicolith-related acute appendicitis have not been established. We aimed to clarify the clinical features of appendicolith-associated appendicitis and determine an appropriate treatment strategy based on the initial presentation.

We retrospectively reviewed the records of 479 consecutive patients with acute appendicitis and verified the therapeutic strategy as per the appendicolith and clinical status.

Appendicoliths were identified in 214 of 479 patients (44.6%) using computed tomography. Surgery was more frequently required in patients with appendicolith than in patients without appendicolith (82.7 versus 64.9%; P < 0.001). The stones were smaller and serum C-reactive protein (CRP) concentration was lower among patients with appendicoliths treated with medication alone than among those surgically treated (both P < 0.001). An appendicolith measuring ≤5 mm in diameter and CRP concentration ≤5.36 mg/dL were predictive of completion of nonsurgical therapy. CRP concentration >10 mg/dL and stone diameter of 10 mm were significantly associated with appendiceal perforation.

Nonsurgical therapy could be considered for patients with appendicoliths measuring ≤5 mm in diameter and in cases where the serum CRP concentration is ≤5 mg/dL. An appendicolith measuring >10 mm in diameter or CRP concentration >10 mg/dL is an indication for surgery.

Appendicolith can cause appendiceal obstruction and acute appendicitis. Its high prevalence may be related to the high perforation rate in pediatric appendicitis. This study assessed the characteristics of appendicolith and its clinical significance in pediatric appendicitis.

A retrospective study was performed among children and adolescents younger than 17 years who were preoperatively diagnosed with appendicitis in the pediatric emergency department (ED). A total of 269 patients with a mean age of 9.98 ± 3.37 years were enrolled. Clinical features and contrast-enhanced computed tomography findings were analyzed.

Among the 269 patients, 147 (54.6%) had appendicoliths, with a mean maximal diameter of 5.21 ± 2.34 mm. Compared to the no appendicolith group, the appendicolith group demonstrated more prolonged abdominal pain (≥ 48 hours) before the ED visit (23.1% vs. 11.5%; P = 0.013), clinical features of severe appendicitis (presence of fever, vomiting, positive urine ketone, and increased C-reactive protein), and higher rate of perforation (43.5% vs. 9.8%; P < 0.001). Multivariate risk factor analysis for perforated appendicitis in the appendicolith group revealed that maximal diameter of 5 mm or more in the appendicolith (adjusted odds ratio [aOR] 2.919; 95% CI 1.325-6.428, P = 0.008) and proximal collapse adjacent to the appendicolith (aOR 2.943; 95% CI 1.344-6.443, P = 0.007) were significant.

Pediatric appendicitis with appendicolith often presents with prolonged abdominal pain and severe clinical conditions with a high risk of perforation.

Purpose To perform a systematic review and meta-analysis to identify computed tomographic (CT) features for differentiating complicated appendicitis in patients suspected of having appendicitis and to summarize their diagnostic accuracy. Materials and Methods Studies on diagnostic accuracy of CT features for differentiating complicated appendicitis (perforated or gangrenous appendicitis) in patients suspected of having appendicitis were searched in Ovid-MEDLINE, EMBASE, and the Cochrane Library. Overlapping descriptors used in different studies to denote the same image finding were subsumed under a single CT feature. Pooled diagnostic accuracy of the CT features was calculated by using a bivariate random effects model. CT features with pooled diagnostic odds ratios with 95% confidence intervals not including 1 were considered as informative. Results Twenty-three studies were included, and 184 overlapping descriptors for various CT findings were subsumed under 14 features. Of these, 10 features were informative for complicated appendicitis. There was a general tendency for these features to show relatively high specificity but low sensitivity. Extraluminal appendicolith, abscess, appendiceal wall enhancement defect, extraluminal air, ileus, periappendiceal fluid collection, ascites, intraluminal air, and intraluminal appendicolith showed pooled specificity greater than 70% (range, 74%-100%), but sensitivity was limited (range, 14%-59%). Periappendiceal fat stranding was the only feature that showed high sensitivity (94%; 95% confidence interval: 86%, 98%) but low specificity (40%; 95% confidence interval, 23%, 60%). Conclusion Ten informative CT features for differentiating complicated appendicitis were identified in this study, nine of which showed high specificity, but low sensitivity. ^© RSNA, 2017 Online supplemental material is available for this article.

A man in his early thirties presented to our clinic with right lower abdominal pain. Computed tomography (CT) and ultrasonography (US) revealed a swollen appendix and an appendicolith. Abscess formation was not observed but ongoing appendiceal rupture was not ruled out. Three months after successful conservative therapy, the lumen of the apical portion was kept dilated and laparoscopic interval appendectomy was performed. No tumorous findings were observed macroscopically. However, histology revealed many tiny nests infiltrating the submucosa, muscular layer, and subserosa at the root of the appendix. An appendiceal neuroendocrine tumor G1 (NET G1; carcinoid) was diagnosed immunohistologically. Neither CT nor US visualized the tumor because of its non-tumor-forming but infiltrative growth. In conclusion, after successful conservative treatment, interval appendectomy should be considered to uncover a possible appendiceal NET G1 (carcinoid), particularly when dilatation of the distal lumen is kept under observation.

The aim of the present study was to investigate the significance of appendicoliths as an exacerbating factor of acute appendicitis using multivariate analysis. A total of 254 patients with pathologically proved acute appendicitis were enrolled in this retrospective study (male, 51 %; mean age, 40.1 years; range, 15-91 years). Two radiologists performed a consensus evaluation of preoperative CT images for the presence of appendicoliths in consensus. When there were appendicoliths, they assessed the number and location of appendicoliths, and measured the longest diameter of the largest appendicolith. Pathological diagnosis was used for the reference standard. The relationships of appendicoliths to gangrenous appendicitis and to perforated appendicitis were each assessed with multiple logistic regression models, which were adjusted for demographic and clinical characteristics of patients. Significant relationships were identified between gangrenous appendicitis and the presence of appendicoliths (OR, 2.2; 95 % CI, 1.2-4.0), the largest appendicolith more than 5 mm in the longest (OR, 3.0; 95 % CI, 1.6-5.7), and location of an appendicolith at the root of the appendix (OR, 2.0; 95 % CI, 1.1-3.8). Among the CT characteristics, the location of an appendicolith at the root of the appendix only showed significant relationship with perforated appendicitis (OR, 4.5; 95 % CI, 1.4-15.4). Size of the largest appendicolith and location of appendicoliths at the root of the appendix are exacerbating factors of acute appendicitis.

The aim of this study was to evaluate the predictive value of intraluminal air for appendiceal necrosis and/or perforation when not apparent on imaging. Additional factors of intraluminal appendicoliths, age, and gender were also assessed.

Patients with pathologically proven appendicitis who underwent multidetector computed tomographic imaging over a 3-year period (n = 487) were retrospectively reviewed. Those with imaging evidence for perforation were excluded to create a study population of apparent uncomplicated acute appendicitis (n = 374). Each scan was assessed for intraluminal appendiceal air and appendicoliths on multidetector computed tomography and compared against surgical and pathologic results for appendiceal necrosis and/or perforation.

Image-occult necrosis or perforation was present in 17.4% (65 or 374) of the study cohort. Intraluminal air and appendicoliths were predictive variables by univariate logistic regression (P = .001 and P ≤ .001, respectively), with odds ratios of 2.64 (95% confidence interval, 1.48-4.73) for intraluminal air and 2.67 (95% confidence interval, 1.55-4.61) for appendicoliths. Both remained independent variables on multivariate modeling despite multicollinearity. Increasing age was also predictive (odds ratio, 1.25; 95% confidence interval, 1.09-1.44; P = .002), whereas gender was not (P = .472).

Intraluminal appendiceal air in the setting of acute appendicitis is a marker of perforated or necrotic appendicitis. Recognition of this finding in otherwise uncomplicated appendicitis at imaging should raise suspicion for image-occult perforation or necrosis.