University of Otago, Christchurch, New Zealand.
Department of General Surgery, Christchurch, New Zealand.
World J Emerg Surg. 2023 Mar 14;18(1):18. doi: 10.1186/s13017-023-00486-8.
Despite acute appendicitis is one of the most common surgical emergencies, its aetiology remains incompletely understood.
This study aimed to assess the rate at which faecoliths were present in acute appendicitis treated with appendicectomy and whether their presence was associated with complicated appendicitis.
All adult patients who underwent appendicectomy for acute appendicitis in a 2 years period (January 2018 and December 2019) at a single institution were retrospectively reviewed. The presence of a faecolith was identified by at least one of three methods: pre-operative CT scan, intraoperative identification, or histopathology report. Patients were grouped according to the presence or absence of a faecolith and demographics, type of appendicitis and surgical outcomes analysed. Complicated appendicitis was defined as appendicitis with perforation, gangrene and/or periappendicular abscess formation.
A total of 1035 appendicectomies were performed with acute appendicitis confirmed in 860 (83%), of which 314 (37%) were classified as complicated appendicitis. Three hundred thirty-nine (35%) of the appendicitis cases had faecoliths (complicated 165/314 cases; 53%; uncomplicated 128/546; 23%, p < 0.001). The presence of a faecolith was associated with higher complications and a subsequent longer post-operative stay.
The rigorous methodology of this study has demonstrated a higher rate of faecolith presence in acute appendicitis than previously documented. It reinforces the association of faecoliths with a complicated disease course and the importance in prioritising emergency surgery and postoperative monitoring for complications.
尽管急性阑尾炎是最常见的外科急症之一，但它的病因仍不完全清楚。
本研究旨在评估在接受阑尾切除术治疗的急性阑尾炎中粪石的存在率，以及其存在是否与复杂阑尾炎有关。
回顾性分析了 2018 年 1 月至 2019 年 12 月期间在一家机构接受阑尾切除术治疗的所有急性阑尾炎成年患者。通过至少三种方法之一确定粪石的存在：术前 CT 扫描、术中识别或组织病理学报告。根据粪石的存在与否将患者分为两组，并分析人口统计学、阑尾炎类型和手术结果。复杂阑尾炎定义为伴有穿孔、坏疽和/或阑尾周围脓肿形成的阑尾炎。
共进行了 1035 例阑尾切除术，其中 860 例（83%）证实为急性阑尾炎，其中 314 例（37%）为复杂阑尾炎。339 例（35%）的阑尾炎病例有粪石（复杂阑尾炎 165/314 例；53%；非复杂阑尾炎 128/546 例；23%，p<0.001）。粪石的存在与更高的并发症发生率和随后更长的术后住院时间相关。
本研究严格的方法学证明了急性阑尾炎中粪石存在的比率高于先前记录的比率。它强化了粪石与复杂病程的关联，以及对急诊手术和术后并发症监测的重视。
