Retrospective Cohort Study
Copyright ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. Oct 27, 2024; 16(10): 3123-3132
Published online Oct 27, 2024. doi: 10.4240/wjgs.v16.i10.3123
Clinical significance of peri-appendiceal abscess and phlegmon in acute complicated appendicitis patients undergoing emergency appendectomy
Ling-Qiang Min, Jing Lu, Hong-Yong He
Ling-Qiang Min, Hong-Yong He, Department of General Surgery/Emergency Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, China
Jing Lu, Department of Nursing, Zhongshan Hospital, Fudan University, Shanghai 200032, China
Co-first authors: Ling-Qiang Min and Jing Lu.
Author contributions: Min LQ and Lu J contributed equally to this work, and they collected and analyzed the data and wrote the manuscript; He HY designed the study and edited the manuscript; all authors have read and approved the final manuscript.
Supported by The National Natural Science Foundation of China, No. 82373417; The Natural Science Foundation of Shanghai, China, No. 23ZR1409900; and The Clinical Research Fund of Zhongshan Hospital, Fudan University, China, No. ZSLCYJ202343.
Institutional review board statement: This study was approved by the Clinical Research Ethics Committee of Zhongshan Hospital of Fudan University (B2024-321).
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: No additional data are available.
STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Hong-Yong He, MD, PhD, Associate Chief Physician, Department of General Surgery/Emergency Surgery, Zhongshan Hospital, Fudan University, No. 180 Fenglin Road, Shanghai 200032, China. he.hongyong@zs-hospital.sh.cn
Received: July 5, 2024
Revised: August 21, 2024
Accepted: September 2, 2024
Published online: October 27, 2024
Processing time: 84 Days and 13.7 Hours
Abstract
BACKGROUND

Although antibiotic therapy has become the primary treatment for acute uncomplicated appendicitis, the management of acute complicated appendicitis necessitates careful consideration of various treatment options.

AIM

To analyze the clinical data of patients who underwent emergency appendectomy for acute complicated appendicitis with peri-appendiceal abscess or phlegmon, identify factors influencing the postoperative length of hospital stay (LOS), and improve treatment strategies.

METHODS

The clinical data of acute complicated appendicitis patients with peri-appendiceal abscess or phlegmon who underwent emergency appendectomy at The Department of Emergency Surgery, Zhongshan Hospital, Fudan University from January 2016 to March 2023 were retrospectively analyzed.

RESULTS

A total of 234 patients were included in our study. The duration of symptoms and the presence of an appendicolith were significantly correlated with the occurrence of peri-appendiceal abscess in patients with acute complicated appendicitis (P < 0.001 and P = 0.015, respectively). Patients with symptoms lasting longer than 72 h had a significantly longer postoperative LOS compared to those with symptoms lasting 72 h or less [hazard ratio (HR), 1.208; 95%CI: 1.107-1.319; P < 0.001]. Additionally, patients with peri-appendiceal abscesses had a significantly longer postoperative LOS compared to those with phlegmon (HR, 1.217; 95%CI: 1.095-1.352; P < 0.001). The patients with peri-appendiceal abscesses were divided into two groups based on the median size of the abscess: Those with abscesses smaller than 5.0 cm (n = 69) and those with abscesses 5.0 cm or larger (n = 82). Patients with peri-appendiceal abscesses measuring 5.0 cm or larger had a significantly longer postoperative LOS than those with abscesses smaller than 5.0 cm (P = 0.038).

CONCLUSION

The duration of symptoms and the presence of an appendicolith are significant risk factors for the formation of peri-appendiceal abscesses in patients with acute complicated appendicitis. Patients with peri-appendiceal abscesses experience a significantly longer postoperative LOS compared to those with peri-appendiceal phlegmon.

Keywords: Acute complicated appendicitis; Abscess; Phlegmon; Appendectomy; Appendicolith

Core Tip: This study explored the clinical implications of peri-appendiceal abscess and phlegmon in the surgical management of acute complicated appendicitis. Through a single-center retrospective analysis, we found that the presence of a peri-appendiceal abscess significantly predicts an extended postoperative hospital stay for patients with acute complicated appendicitis. These findings highlight the importance of considering conservative treatment options in patients presenting with a peri-appendiceal abscess.