Kupietzky A, Bar-Moshe Y, Lavie N, Drayer Lichtman M, Dover R, Juster EY, Maden A, Mazeh H, Mizrahi I. Leaving no stone unturned: Impact of appendicolith and characteristics on long-term recurrence after non-operative appendicitis. World J Clin Cases 2025; 13(23): 106532 [DOI: 10.12998/wjcc.v13.i23.106532]
Corresponding Author of This Article
Amram Kupietzky, MD, Department of Surgery, Hadassah Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Sderot Churchill 8, Jerusalem 91240, Israel. amramkupietzky@gmail.com
Research Domain of This Article
Surgery
Article-Type of This Article
Retrospective Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (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: http://creativecommons.org/licenses/by-nc/4.0/
World J Clin Cases. Aug 16, 2025; 13(23): 106532 Published online Aug 16, 2025. doi: 10.12998/wjcc.v13.i23.106532
Leaving no stone unturned: Impact of appendicolith and characteristics on long-term recurrence after non-operative appendicitis
Amram Kupietzky, Yehonatan Bar-Moshe, Nofar Lavie, Moriya Drayer Lichtman, Roi Dover, Eyal Yonathan Juster, Ata Maden, Haggi Mazeh, Ido Mizrahi
Amram Kupietzky, Moriya Drayer Lichtman, Roi Dover, Eyal Yonathan Juster, Ata Maden, Haggi Mazeh, Ido Mizrahi, Department of Surgery, Hadassah Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem 91240, Israel
Yehonatan Bar-Moshe, Department of Radiology, Hadassah Medical Organization and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem 91240, Israel
Nofar Lavie, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem 12000, Israel
Author contributions: Kupietzky A participated in the literature search, study design, data collection, data analysis, data interpretation, writing, critical revision; Bar-Moshe Y reviewed all ultrasound and computed tomography scans, participated in data collection, and made substantial contributions to critically reviewing the research and manuscript; Lavie N, Drayer Lichtman M, Dover R, Juster EY and Maden A participated in the data collection, data analysis, data interpretation, and critical revision; Mazeh H and Mizrahi I had substantial contributions to study design, data analysis, data interpretation, writing, critical revision; all of the authors read and approved the final version of the manuscript to be published.
Institutional review board statement: The study was reviewed and approved by the Hadassah Medical Center Institutional Review Board (No. HMO-0009-23).
Informed consent statement: The need for informed consent was waived by our institutional review board, due to the retrospective nature of the study.
Conflict-of-interest statement: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.
Data sharing statement: No additional data are available.
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: Amram Kupietzky, MD, Department of Surgery, Hadassah Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Sderot Churchill 8, Jerusalem 91240, Israel. amramkupietzky@gmail.com
Received: February 28, 2025 Revised: April 6, 2025 Accepted: April 24, 2025 Published online: August 16, 2025 Processing time: 96 Days and 11 Hours
Abstract
BACKGROUND
Non-operative management (NOM) for uncomplicated acute appendicitis (AA) has been gaining popularity in recent years. One of the major concerns with NOM is the recurrence rate of AA following NOM.
AIM
To investigate the impact of the presence of an appendicolith and its specific characteristics on the recurrence rate of AA following NOM.
METHODS
A retrospective analysis identified all patients treated with NOM for AA, at our institute between 2016 and 2024. Patients with an appendicolith on imaging were identified and their course and outcomes were compared with patients who were treated with NOM without an appendicolith. The primary outcome was defined as a recurrence of AA.
RESULTS
During the study period, 797 patients were treated with NOM for AA. Their mean age was 25.4 years ± 14.4 years, and 45.4% were females. Only 68 patients (8.5%) had an appendicolith identified on imaging. Patients with an appendicolith had a larger appendix diameter (10.2 mm ± 4 mm vs 8.5 mm ± 2.1 mm, P = 0.001). There was no difference in the recurrence rate of patients with and without an appendicolith (26.5% vs 19.1%, P = 0.14), however patients with an appendicolith presented with a shorter time to recurrence of appendicitis (3.9 months ± 10.4 months vs 5.9 months ± 8.1 months, P = 0.04). In a sub analysis, the number of appendicoliths, its size, and its location, did not influence the recurrence rate.
CONCLUSION
This study demonstrates that patients with appendicoliths have a shorter time to recurrence after NOM of AA, but do not experience higher overall recurrence rates.
Core Tip: This study evaluates the impact of appendicolith presence and characteristics on recurrence after non-operative management (NOM) of acute appendicitis. While appendicoliths do not increase overall recurrence rates, they are associated with a shorter time to recurrence. These findings contribute to risk stratification and may help refine patient selection and follow-up strategies for NOM.
