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Does the presence of an appendicolith or abscess predict failure of nonoperative management of patients with acute appendicitis?

Purpose Nonoperative management (NOM) has been widely accepted as one of the standard treatments for patients with acute appendicitis. However, predictive factors for the failure of NOM have not been thoroughly investigated. Methods A total of 196 patients with acute appendicitis underwent NOM betwe...

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Published in:Emergency radiology 2021-10, Vol.28 (5), p.977-983
Main Authors: Kohga, Atsushi, Kawabe, Akihiro, Yajima, Kiyoshige, Okumura, Takuya, Yamashita, Kimihiro, Isogaki, Jun, Suzuki, Kenji, Muramatsu, Katsuaki
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creator Kohga, Atsushi
Kawabe, Akihiro
Yajima, Kiyoshige
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Isogaki, Jun
Suzuki, Kenji
Muramatsu, Katsuaki
description Purpose Nonoperative management (NOM) has been widely accepted as one of the standard treatments for patients with acute appendicitis. However, predictive factors for the failure of NOM have not been thoroughly investigated. Methods A total of 196 patients with acute appendicitis underwent NOM between April 2014 and December 2020. Of these 196 patients, 24 patients failed NOM and required emergency surgery (failure group: n  = 24), while the other 172 patients were successfully treated with NOM (success group: n  = 172). These two groups were compared, and the predictive factors for the failure of NOM were investigated. Results The number of patients who had a previous history of stroke was significantly increased in the failure group (12.5% vs. 2.9%, p  = 0.026). Incarceration of an appendicolith on CT images was significantly associated with the failure group (20.8% vs. 1.7%, p  
doi_str_mv 10.1007/s10140-021-01951-0
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However, predictive factors for the failure of NOM have not been thoroughly investigated. Methods A total of 196 patients with acute appendicitis underwent NOM between April 2014 and December 2020. Of these 196 patients, 24 patients failed NOM and required emergency surgery (failure group: n  = 24), while the other 172 patients were successfully treated with NOM (success group: n  = 172). These two groups were compared, and the predictive factors for the failure of NOM were investigated. Results The number of patients who had a previous history of stroke was significantly increased in the failure group (12.5% vs. 2.9%, p  = 0.026). Incarceration of an appendicolith on CT images was significantly associated with the failure group (20.8% vs. 1.7%, p  &lt; 0.001), while neither the presence of an appendicolith nor abscess was associated. The presence of periappendiceal fluid was significantly associated with the failure group (50.0% vs. 26.7%, p  = 0.019). The incarceration of an appendicolith ( p  &lt; 0.001, odds ratio = 19.85) and periappendiceal fluid ( p  = 0.009, odds ratio = 3.62) were found to be independent risk factors for failure of NOM. Neither the presence of an appendicolith nor abscess was associated with the recurrence of appendicitis. Conclusions The presence of an appendicolith or abscess was not a crucial factor for surgery. Incarceration of an appendicolith and periappendiceal fluid on CT images was predictive factors for the failure of NOM.</description><identifier>ISSN: 1070-3004</identifier><identifier>EISSN: 1438-1435</identifier><identifier>DOI: 10.1007/s10140-021-01951-0</identifier><language>eng</language><publisher>Cham: Springer International Publishing</publisher><subject>Abscesses ; Appendicitis ; Computed tomography ; Emergency Medicine ; Failure ; Imaging ; Imprisonment ; Medical imaging ; Medicine ; Medicine &amp; Public Health ; Original Article ; Radiology ; Risk analysis ; Surgery</subject><ispartof>Emergency radiology, 2021-10, Vol.28 (5), p.977-983</ispartof><rights>American Society of Emergency Radiology 2021</rights><rights>American Society of Emergency Radiology 2021.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c352t-3822f493e2f65c7fecd38ef6e12660987f18c830fb725a3230beea115b82234a3</citedby><cites>FETCH-LOGICAL-c352t-3822f493e2f65c7fecd38ef6e12660987f18c830fb725a3230beea115b82234a3</cites><orcidid>0000-0001-8949-2950</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,777,781,27905,27906</link.rule.ids></links><search><creatorcontrib>Kohga, Atsushi</creatorcontrib><creatorcontrib>Kawabe, Akihiro</creatorcontrib><creatorcontrib>Yajima, Kiyoshige</creatorcontrib><creatorcontrib>Okumura, Takuya</creatorcontrib><creatorcontrib>Yamashita, Kimihiro</creatorcontrib><creatorcontrib>Isogaki, Jun</creatorcontrib><creatorcontrib>Suzuki, Kenji</creatorcontrib><creatorcontrib>Muramatsu, Katsuaki</creatorcontrib><title>Does the presence of an appendicolith or abscess predict failure of nonoperative management of patients with acute appendicitis?</title><title>Emergency radiology</title><addtitle>Emerg Radiol</addtitle><description>Purpose Nonoperative management (NOM) has been widely accepted as one of the standard treatments for patients with acute appendicitis. However, predictive factors for the failure of NOM have not been thoroughly investigated. Methods A total of 196 patients with acute appendicitis underwent NOM between April 2014 and December 2020. Of these 196 patients, 24 patients failed NOM and required emergency surgery (failure group: n  = 24), while the other 172 patients were successfully treated with NOM (success group: n  = 172). These two groups were compared, and the predictive factors for the failure of NOM were investigated. Results The number of patients who had a previous history of stroke was significantly increased in the failure group (12.5% vs. 2.9%, p  = 0.026). Incarceration of an appendicolith on CT images was significantly associated with the failure group (20.8% vs. 1.7%, p  &lt; 0.001), while neither the presence of an appendicolith nor abscess was associated. The presence of periappendiceal fluid was significantly associated with the failure group (50.0% vs. 26.7%, p  = 0.019). The incarceration of an appendicolith ( p  &lt; 0.001, odds ratio = 19.85) and periappendiceal fluid ( p  = 0.009, odds ratio = 3.62) were found to be independent risk factors for failure of NOM. Neither the presence of an appendicolith nor abscess was associated with the recurrence of appendicitis. Conclusions The presence of an appendicolith or abscess was not a crucial factor for surgery. Incarceration of an appendicolith and periappendiceal fluid on CT images was predictive factors for the failure of NOM.</description><subject>Abscesses</subject><subject>Appendicitis</subject><subject>Computed tomography</subject><subject>Emergency Medicine</subject><subject>Failure</subject><subject>Imaging</subject><subject>Imprisonment</subject><subject>Medical imaging</subject><subject>Medicine</subject><subject>Medicine &amp; Public Health</subject><subject>Original Article</subject><subject>Radiology</subject><subject>Risk analysis</subject><subject>Surgery</subject><issn>1070-3004</issn><issn>1438-1435</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2021</creationdate><recordtype>article</recordtype><recordid>eNp9kU1LxDAQhoso-PkHPAW8eKlOkqZpTyJ-g-BFzyGbnayVblKTVPHmTzfdFQUPXmaGmed9SXiL4pDCCQWQp5ECraAERkugrch1o9ihFW_KXMRmnkFCyQGq7WI3xhcAqNu62Sk-Lz1Gkp6RDAEjOoPEW6Id0cOAbt4Z33fpmfhA9CwajHHi8joRq7t-DCvceecHDDp1b0iW2ukFLtGl6TTkZR4jeZ9stBkT_lh3qYtn-8WW1X3Eg---VzxdXz1e3Jb3Dzd3F-f3peGCpZI3jNmq5chsLYy0aOa8QVsjZXUNbSMtbUzDwc4kE5ozDjNETamYZSGvNN8rjte-Q_CvI8akll3-UN9rh36MiolKiFbWrM3o0R_0xY_B5ddlSjLJWioniq0pE3yMAa0aQrfU4UNRUFMoah2KyqGoVSgKsoivRTHDboHh1_of1RfwdJB-</recordid><startdate>20211001</startdate><enddate>20211001</enddate><creator>Kohga, Atsushi</creator><creator>Kawabe, Akihiro</creator><creator>Yajima, Kiyoshige</creator><creator>Okumura, Takuya</creator><creator>Yamashita, Kimihiro</creator><creator>Isogaki, Jun</creator><creator>Suzuki, Kenji</creator><creator>Muramatsu, Katsuaki</creator><general>Springer International Publishing</general><general>Springer Nature B.V</general><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7RV</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8FE</scope><scope>8FG</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>ARAPS</scope><scope>BENPR</scope><scope>BGLVJ</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>HCIFZ</scope><scope>K9.</scope><scope>KB0</scope><scope>M0S</scope><scope>M1P</scope><scope>NAPCQ</scope><scope>P5Z</scope><scope>P62</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0001-8949-2950</orcidid></search><sort><creationdate>20211001</creationdate><title>Does the presence of an appendicolith or abscess predict failure of nonoperative management of patients with acute appendicitis?</title><author>Kohga, Atsushi ; 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However, predictive factors for the failure of NOM have not been thoroughly investigated. Methods A total of 196 patients with acute appendicitis underwent NOM between April 2014 and December 2020. Of these 196 patients, 24 patients failed NOM and required emergency surgery (failure group: n  = 24), while the other 172 patients were successfully treated with NOM (success group: n  = 172). These two groups were compared, and the predictive factors for the failure of NOM were investigated. Results The number of patients who had a previous history of stroke was significantly increased in the failure group (12.5% vs. 2.9%, p  = 0.026). Incarceration of an appendicolith on CT images was significantly associated with the failure group (20.8% vs. 1.7%, p  &lt; 0.001), while neither the presence of an appendicolith nor abscess was associated. The presence of periappendiceal fluid was significantly associated with the failure group (50.0% vs. 26.7%, p  = 0.019). The incarceration of an appendicolith ( p  &lt; 0.001, odds ratio = 19.85) and periappendiceal fluid ( p  = 0.009, odds ratio = 3.62) were found to be independent risk factors for failure of NOM. Neither the presence of an appendicolith nor abscess was associated with the recurrence of appendicitis. Conclusions The presence of an appendicolith or abscess was not a crucial factor for surgery. Incarceration of an appendicolith and periappendiceal fluid on CT images was predictive factors for the failure of NOM.</abstract><cop>Cham</cop><pub>Springer International Publishing</pub><doi>10.1007/s10140-021-01951-0</doi><tpages>7</tpages><orcidid>https://orcid.org/0000-0001-8949-2950</orcidid></addata></record>
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subjects Abscesses
Appendicitis
Computed tomography
Emergency Medicine
Failure
Imaging
Imprisonment
Medical imaging
Medicine
Medicine & Public Health
Original Article
Radiology
Risk analysis
Surgery
title Does the presence of an appendicolith or abscess predict failure of nonoperative management of patients with acute appendicitis?
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