Acute Catarhal Appendicitis — Diagnosis and Treatment

RELEVANCE At present, despite the dynamic progress in urgent abdominal surgery, based on the introduction of advances in medical technology and, as a consequence, the development of non-invasive and minimally invasive diagnostic and treatment technologies, the problem of diagnosis and treatment of the catarrhal form of acute appendicitis (acutis appendicitis forma catarrhalis) remains relevant.

THE AIM was to improve the outcomes of endovideolaparoscopic appendectomy by optimizing the differentiation of pathomorphological forms of acute appendicitis based on the results of non-invasive and minimally invasive diagnostic and treatment methods.

MATERIAL AND METHODS In the surgical department of the Al-Mozn Medical Complex (Arab Republic of Libya), 182 patients underwent appendectomy using endovideolaparoscopic technology from 2019 to 2024. This work is based on the analysis of 128 patients who underwent appendectomy using endovideolaparoscopic technology; in 54 (29.7%) patients out of 182, the surgical technique had distinctive features that were the subject of further research.

24 patients with different abdominal surgical pathology, surgical correction of which was possible using endovideolaparoscopic access, were examined to assess the non-inflamed appendix (according to ultrasound and endovideolaparoscopy) as a comparison group.

RESULTS 22 (17.2%) patients were diagnosed with the catarrhal form (acutis appendicitis forma catarrhalis), 89 (69.5%) with the phlegmonous form (acutus appendicitis forma phlegmonous), and 17 (13.3%) with the gangrenous form (acutus appendicitis forma gangreno). A total of 128 (100%) patients.

CONCLUSIONS Inconsistency of symptoms in the group of patients with acute catarrhal appendicitis complicates primary clinical diagnosis. The results of non-invasive diagnostic methods showed that the sensitivity of ultrasound was 87.6%; however, this method of research is ineffective in identifying the catarrhal form. The degree of effectiveness of ultrasound is directly proportional to the destructive changes in the appendix. The diagnostic accuracy of endovideolaparoscopy is 96%. This diagnostic method is effective and preferable in diagnosing the catarrhal form.

1. van Dijk ST, van Dijk AH, Dijkgraaf MG, Boermeester MA. Meta-analysis of in-hospital delay before surgery as a risk factor for complications in patients with acute appendicitis. Br J Surg. 2018;105(8):933–945. PMID: 29902346 https://doi.org/10.1002/bjs.10873

2. Sibia US, Onayemi AO, Turcotte JJ, Klune JR, Wormuth J, Buckley BM. Bundled payments for appendectomy: a model of financial implications to institutions. J Gastrointest Surg. 2020;24(3):643–649. PMID: 30840183 https://doi.org/10.1007/s11605-019-04181-5

3. Young E, Stewart S, McCulloch G, Maddern G. Appendicectomy mortality: an Australian national audit. ANZ J Surg. 2019;89(11):1441–1445. PMID: 31566305 https://doi.org/10.1111/ans.15439

4. Revishvili ASh, Olovyanniy VE, Kalinin DV, Kuznetsov AV. Mortality in acute appendicitis in Russia. Pirogov Russian Journal of Surgery. 2022;(10):5–14. (In Russ.). https://doi.org/10.17116/hirurgia20221015

5. Khadjibaev FA, Karimov DR, Madiev RZ, Rahimova RA. Possibilities of Ultrasound Examination in the Diagnosis of Destructive Forms of Acute Appendicitis. The Bulletin of Emergency Medicine. 2021;14(5):101–105. (In Russ.). https://doi.org/10.54185/TBEM/vol14_iss5/a17

6. Meeks DW, Kao LS. Controversies in appendicitis. Surg Infect (Larchmt). 2008;9(6):553–558. PMID: 19216665 https://doi.org/10.1089/sur.2008.9954

7. Mishra RK, Hanna GB, Cuschieri A. Laparoscopic versus open appendectomy for the treatment of acute appendicitis. World J Laparosc Surg. 2008;1(1):19–28.

8. Ukhanov AP, Zakharov DV, Bol’shakov SV, Zhilin SA, Leonov AI, Ambartsumyan VM. Laparoscopic appendectomy — the «gold standard» technique for all kinds of acute appendicitis. Endoscopic Surgery. 2018;24(2):3–7. (In Russ.). https://doi.org/10.17116/endoskop20182423

9. Revishvili ASh, Fedorov AV, Sazhin VP, Oloviannyī VE. Emergency surgery in Russian Federation. Pirogov Russian Journal of Surgery. 2019;(3):88–97. (In Russ.). https://doi.org/10.17116/hirurgia201903188

10. Zatevakhin II, Sazhin AV, Kirienko AI, Nechay TV, Tyagunov AE, Titkova SM, et al. Diagnostic and Treatment Approaches for Acute Appendicitis in the Russian Federation. Results of the All-Russian Survey. Pirogov Russian Journal of Surgery. 2020;(8):5–16. (In Russ.). https://doi.org/10.17116/hirurgia20200815

11. Yamada T, Endo H, Hasegawa H, Kimura T, Kakeji Y, Koda K, et al. Risk of emergency surgery for complicated appendicitis: Japanese nationwide study. Ann Gastroenterol Surg. 2020;5(2):236–242. PMID: 33860144 https://doi.org/10.1002/ags3.12408 eCollection 2021 Mar.

12. Galimov OV, Khanov VO, Minigalin DM, Galimov DO, Safargalina AG, Galiullin DF. Laparoscopic Surgery for Acute Appendicitis Complicated by Peritonitis. Creative surgery and oncology. 2023;13(1):33–38. (In Russ.). https://doi.org/10.24060/2076-3093-2023-13-1-33-38

13. Timerbulatov ShV, Timerbulatov MV, Fedorov SV, Gafarova AR, Timerbulatov VM, Sibaev VM. Acute Appendicitis: How Often is Appendectomy Negative? Creative surgery and oncology. 2023;13(2):112–118. (In Russ.). https://doi.org/10.24060/2076-3093-2023-13-2-112-118