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Should All Complicated Appendicitis Be Treated the Same? The Answer Is No.

Victoria Wang, Diego Kriger, Elias Fanous

    The American Surgeon
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    This summary is machine-generated.

    Delayed appendicitis outcomes depend on CT findings, not just presentation time. Early appendectomy in uncomplicated cases reduces hospitalization and adverse events, showing safety in selected patients.

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    Area of Science:

    • Surgical Gastroenterology
    • Emergency Medicine
    • Radiology

    Background:

    • Delayed presentation of acute appendicitis (>72 hours) is linked to higher complication rates.
    • Radiologic findings may be more critical than presentation delay in determining appendicitis outcomes.

    Purpose of the Study:

    • To investigate if appendectomy outcomes in delayed acute appendicitis depend more on radiologic findings than the delay itself.

    Main Methods:

    • Retrospective review of 138 patients with delayed appendicitis (2009-2015).
    • Classification into uncomplicated appendicitis (UA), phlegmon/abscess (PA), and perforated appendicitis (PERF) based on CT scans.
    • Comparison of outcomes between early appendectomy (EA) and initial conservative management.

    Main Results:

    • Adverse events were significantly lower with EA (17%) versus conservative management (42%).
    • EA in the UA group led to shorter hospitalization and fewer adverse events compared to conservative management.
    • Severe adverse events, including colectomies and fecal fistula, occurred in the PA group.

    Conclusions:

    • Complicated appendicitis is frequent in delayed presentations.
    • Early appendectomy is safe and effective for selected patients with delayed appendicitis, reducing adverse events.
    • Radiologic findings are key determinants of outcomes in delayed appendicitis cases.