[Clinical characteristics of recurrent appendicitis]

Area of Science:

• Gastroenterology
• Surgical Pathology
• Clinical Epidemiology

Background:

• Appendicitis is a common surgical emergency, but recurrent cases present unique clinical challenges.
• Understanding the distinct characteristics of recurrent appendicitis is crucial for accurate diagnosis and management.
• Previous studies have not fully elucidated the specific clinical profile differentiating recurrent from first-episode appendicitis.

Purpose of the Study:

• To analyze and compare the clinical characteristics of patients with recurrent acute appendicitis versus those experiencing a first episode.
• To identify key features that may predict or indicate recurrent appendicitis.
• To provide data that can aid in the clinical decision-making process for patients with suspected appendicitis.

Main Methods:

• A retrospective cohort study analyzed clinical data of 373 patients who underwent appendectomy for acute appendicitis.
• Patients were divided into a recurrent group (133 cases) and a first episode group (240 cases).
• Clinical characteristics, including demographics, comorbidities, symptom onset, physical examination findings, laboratory results, and CT scan findings, were compared between the two groups.

Main Results:

• The recurrent appendicitis group showed a higher proportion of patients younger than 50 years (71.4%) and those with concurrent diabetes (13.5%).
• Recurrent cases exhibited shorter onset times, less abdominal tenderness/rebound pain, lower modified Alvarado scores, lower white blood cell (WBC) counts, and a higher lymphocyte percentage.
• Appendices in the recurrent group were more frequently longer than 7 cm (44.4%), less complicated (8.3%), and showed a higher incidence of intraluminal appendicoliths (38%) compared to the first episode group.

Conclusions:

• Recurrent acute appendicitis is characterized by specific clinical features: younger age (<50 years), presence of diabetes, shorter symptom duration, and less pronounced abdominal pain.
• Diagnostic indicators for recurrent appendicitis include a low modified Alvarado score, low WBC count, high lymphocyte percentage, elongated appendix (≥7 cm), non-complicated nature, and intraluminal appendicoliths.
• These findings can help clinicians differentiate recurrent appendicitis, potentially improving diagnostic accuracy and patient management strategies.