Department of Digestive Surgery, Amiens University Medical Center, Amiens, France; Jules Verne University of Picardie, Amiens, France.
Department of Digestive Surgery, Amiens University Medical Center, Amiens, France; Jules Verne University of Picardie, Amiens, France; SSPC (simplification des soins des patients chirurgicaux complexes) research unit, Jules Verne University of PIcardie, Amiens, France.
Am J Emerg Med. 2018 Dec;36(12):2232-2235. doi: 10.1016/j.ajem.2018.04.014. Epub 2018 Apr 9.
Fecal appendicular peritonitis (FAP) is a poorly studied, rare form of acute appendicitis, corresponding to peritoneal inflammation with the presence of feces secondary to ruptured appendix. The purpose of this study was to describe FAP and to compare FAP with purulent appendicular peritonitis (PAP).
This single-center, retrospective study was conducted in consecutive patients to compare the FAP group and the PAP group. The primary endpoint was the 30-day postoperative morbidity and mortality according to the Clavien-Dindo classification. The secondary endpoints were description and comparison of intraoperative data (laparoscopy rate, conversion rate, type of procedure and the mean operating time), and short-term outcomes (types of complications, length of stay, readmission rate, and reoperation rate), comparison of intraoperative bacteriological samples of FAP and PAP as well as the rate of resistance to amoxicillin and clavulanic acid, used as routine postoperative antibiotic therapy.
Between January 2006 and January 2016, 2.2% of appendectomies were performed for FAP. Patients of the FAP group reported a longer history of pain than patients of the PAP group (mean: 58 h [range: 24-120] vs 24 h [range: 6-504], p = 0.0001) and hyperthermia was more frequent in the FAP group than in the PAP group (72% vs 26%, p = 0.0001). Mean preoperative CRP was also higher in the FAP group than in the PAP group (110 mg/L [range: 67-468] vs 37.5 mg/L [range: 3.1-560], p = 0.007). Significantly less patients were operated by laparoscopy in the FAP group (89.7% vs 96.6%, p < 0.0001). Mean length of stay was significantly longer in the FAP group than in the PAP group (10 days [range: 3-24] vs 5 days [range: 1-32], p = 0.001). The overall 30-day complication rate was significantly higher in the FAP group than in the PAP group (62.1% vs 24.7%, p = 0.0005). The readmission rate was not significantly different between the two groups (14% vs 11.2%, p = 0.2), but the reoperation rate was higher in the FAP group than in the PAP group (31% vs 11%, p = 0.01). No significant difference was observed between the FAP and PAP groups in terms of the positive culture rate (75.9% vs 65.6%, p = 0.3). No significant difference was observed between the two groups in terms of resistance to amoxicillin and clavulanic acid (18.2% vs 20.5%, p = 0.8).
FAP is associated with significantly more severe morbidity compared to PAP. Clinicians must be familiar with this form of appendicitis in order to adequately inform their patients.
粪便阑尾周围炎（FAP）是一种研究较少的罕见急性阑尾炎形式，对应于阑尾破裂导致粪便进入腹膜而引起的腹膜炎症。本研究旨在描述 FAP 并将其与脓性阑尾周围炎（PAP）进行比较。
这是一项在连续患者中进行的单中心回顾性研究，旨在比较 FAP 组和 PAP 组。主要终点是根据 Clavien-Dindo 分类评估术后 30 天的发病率和死亡率。次要终点是描述和比较术中数据（腹腔镜率、转化率、手术类型和平均手术时间），以及短期结果（并发症类型、住院时间、再入院率和再次手术率），比较 FAP 和 PAP 的术中细菌学样本以及对阿莫西林和克拉维酸的耐药率，该药物作为常规术后抗生素治疗。
2006 年 1 月至 2016 年 1 月期间，2.2%的阑尾切除术是为 FAP 进行的。FAP 组的患者报告疼痛时间长于 PAP 组（平均：58 小时[范围：24-120]与 24 小时[范围：6-504]，p=0.0001），FAP 组的发热更为常见（72%与 26%，p=0.0001）。FAP 组的平均术前 CRP 也高于 PAP 组（110mg/L[范围：67-468]与 37.5mg/L[范围：3.1-560]，p=0.007）。FAP 组接受腹腔镜手术的患者明显减少（89.7%与 96.6%，p<0.0001）。FAP 组的平均住院时间明显长于 PAP 组（10 天[范围：3-24]与 5 天[范围：1-32]，p=0.001）。FAP 组的总体 30 天并发症发生率明显高于 PAP 组（62.1%与 24.7%，p=0.0005）。两组的再入院率无显著差异（14%与 11.2%，p=0.2），但 FAP 组的再次手术率高于 PAP 组（31%与 11%，p=0.01）。FAP 组和 PAP 组的阳性培养率无显著差异（75.9%与 65.6%，p=0.3）。两组对阿莫西林和克拉维酸的耐药率无显著差异（18.2%与 20.5%，p=0.8）。
FAP 与 PAP 相比，发病率明显更高。临床医生必须熟悉这种形式的阑尾炎，以便充分告知患者。
