The role of clinical, radiologic and laboratory markers in distinguishing an appendiceal mucocele from acute appendicitis

Yıl 2024, Cilt: 14 Sayı: 1, 25 - 30, 31.01.2024

Hacı Bolat Alirıza Erdoğan Caner Özbey

https://doi.org/10.16899/jcm.1406168

Öz

ABSTRACT
AIM: This study aims to assist the surgical treatment plan by increasing the rate of correct preoperative diagnoses through comparing the clinical, radiological, and laboratory findings of appendiceal mucocele (AM) and acute appendicitis (AA) before surgery.
MATERIALS AND METHODS: The study included 63 patients with a histopathologic diagnosis of AM and AA among 4867 patients who underwent appendectomy with the diagnosis of acute appendicitis in the general surgery clinic between 2009 and 2020. The patients were separated into two groups: those with AM (21 patients) and those with AA (42 patients). Age, gender, physical examination (PE), Alvarado appendicitis score, ultrasonography (USG), computed tomography (CT), laboratory, preoperative diagnosis, intraoperative diagnosis, and pathological diagnosis results of both groups were compared.

RESULTS: PE, abdominal pain, nausea, vomiting, fever symptoms, and Alvarado score were found to be significant between the two groups (p<0.05). In addition, WBC, NE, LYM %, and CRP were found to be high in group 2 (p<0.05), while there was no difference in radiological diagnosis (USG/CT) between the two groups (p<0.05). However, the appendix diameter was larger in group 1 (p<0.05). Patients with AM in 80% preoperatively, and 52% intraoperatively were operated on with a provisional diagnosis of AA. The second surgery was performed in Group 1 with a rate of 9.5% (2/21).
CONCLUSION: In our study, patients with AM who underwent surgery with a diagnosis of AA were found to differ in radiological, clinical, and laboratory findings from patients with AA.
KEYWORDS: Appendiceal Mucocele, Acute Appendicitis, Differential Diagnosis

Anahtar Kelimeler

Appendiceal Mucocele, Acute Appendicitis, Differential Diagnosis

Etik Beyan

This study was conducted in accordance with the principles of the Declaration of Helsinki. Approval was obtained with the decision of the Ethics Committee of Niğde Ömer Halisdemir University, dated 24.12.2020 and numbered 2020/78.

Apendiks mukoselini akut apandisitten ayırmada klinik, radyolojik ve laboratuvar belirteçlerin rolü

Öz

ÖZET
AMAÇ: Bu çalışmanın amacı; cerrahi öncesi apendiks mukoseli(AM) ile akut apandisit(AA)’i klinik, radyolojik ve laboratuvar sonuçlarını karşılaştırıp ameliyat öncesi doğru tanı oranımızı artırarak cerrahi tedavi planına yardımcı olmaktır.

GEREÇ VE YÖNTEMLER: Çalışmaya 2009-2020 yılları arasında genel cerrahi kliniğinde akut apandisit tanısıyla apendektomi yapılan 4867 hastadan histopatolojik olarak AM ve AA tanısı alan 63 hasta dahil edildi. Hastalar AM'li olanlar (21 hasta) olmak üzere iki gruba ayrıldı. ve AA'lı olanlar (42 hasta). Her iki grubun yaş, cinsiyet, fizik muayene (PE), Alvarado apandisit skoru, ultrasonografi (USG), bilgisayarlı tomografi (BT), laboratuvar, preoperatif tanı, intraoperatif tanı ve patolojik tanı sonuçları karşılaştırıldı.

BULGULAR: PE, karın ağrısı, bulantı, kusma, ateş semptomları ve Alvarado skoru iki grup arasında anlamlı bulundu (p<0,05). Ayrıca grup 2'de WBC, NE, LYM % ve CRP yüksek bulunurken (p<0,05), radyolojik tanı (USG/BT) açısından iki grup arasında fark yoktu (p<0,05). Ancak apendiks çapı grup 1'de daha büyüktü (p<0,05). AM'li hastaların %80'i ameliyat öncesi, %52'si ameliyat sırasında geçici AA tanısıyla ameliyat edildi. İkinci ameliyat ise %9,5 (2/21) oranında Grup 1'de yapıldı.

SONUÇ: Çalışmamızda AA tanısıyla ameliyat edilen AM'li hastaların radyolojik, klinik ve laboratuvar bulgularının AA'lı hastalardan farklı olduğu görüldü.

ANAHTAR KELİMELER: Apendiks Mukosel, Akut Apandisit, Ayırıcı Tanı

Anahtar Kelimeler

Apendiks Mukosel, Akut Apandisit, Ayırıcı Tanı

Kaynakça

• 1. Klingbeil KD, Azab B, Moller MG. Low-grade appendiceal mucinous neoplasm and endometriosis of the appendix. World J Surg Oncol. 2017;15(1).
• 2. Marudanayagam R, Williams GT, Rees BI. Review of the pathological results of 2660 appendicectomy specimens. J Gastroenterol. 2006;41:745–9.
• 3- Yakan S, Caliskan C, Uguz A, Korkut, M. A., Çoker, A. A retrospective study on mucocele of the appendix presented with acute abdomen or acute appendicitis. Hong Kong Journal of Emergency Medicine 18.3 (2011): 144-149.
• 4. Rampone B, Roviello F, Marrelli D, Pinto E. Giant appendiceal mucocele: Report of a case and brief review. World J Gastroenterol . 2005;11(30):4761–3.
• 5. Malya FU, Hasbahceci M, Serter A, et al. Appendiceal Mucocele: Clinical and Imaging Features of 14 CasesDecember Copyright© Celsius. Vol. 109, revistachirurgia.ro. 2014
• 6. Demetrashvili Z, Chkhaidze M, Khutsishvili K, et al. Mucocele of the appendix: Case report and review of literature . Vol. 97, International Surgery. Allen Press; 2012; 266–9.
• 7- Jose T, Rajesh PS. Appendicitis Inflammatory Response Score in Comparison to Alvarado Score in Acute Appendicitis. Surg J (N Y). 2021;7(3):e127-e131.
• 8. Rabie ME, Al Shraim M, Al Skaini MS, et al. Mucus containing cystic lesions “mucocele” of the appendix: The unresolved issues. Int J Surg Oncol. 2015;2015.
• 9. Akbaş A, Aydın Kasap Z, Hacım NA, et al. The value of inflammatory markers in diagnosing acute appendicitis in pregnant patients. Ulus Travma ve Acil Cerrahi Derg. 2020;26(5):769–76.
• 10. Beyrouti MI, Gharbi A, Abid M, et al. Les tumeurs mucosecretantes de l’appindice. A propos de 22 cas. Tunisie Medicale. 2004; 82(12):1101–6.
• 11. Gaetke-Udager K, Maturen KE, Hammer SG. Beyond acute appendicitis: Imaging and pathologic spectrum of appendiceal pathology. Emerg Radiol. 2014;21(5):535–42
• 12. Sökücü N, Balık E. Appendix Tumors, In: Baykan A, Zorluoğlu A, Geçim E, Terzi C (edt), Colon and Rectum Cancers, Turkish Colon and Rectum Surgery Association; 2010. s301.
• 13. Li X, Zhou J, Dong M, Yang L. Management and prognosis of low-grade appendiceal mucinous neoplasms: A clinicopathologic analysis of 50 cases. Eur J Surg Oncol. 2018; 44(10):1640–5.
• 14. Yilmaz M, Akbulut S, Kutluturk K, et al. Unusual histopathological findings in appendectomy specimens from patients with suspected acute appendicitis. World J Gastroenterol. 2013;19(25):4015-4022.
• 15. Basak F, Hasbahceci M, Yucel M, et al. Does it matter if it is appendix mucocele instead of appendicitis? Case series and brief review of literature. J Cancer Res Ther. 2018;14(6):1355–60.
• 16. Mahajan P, Basu T, Pai CW, et al. Factors Associated With Potentially Missed Diagnosis of Appendicitis in the Emergency Department. JAMA Netw open. 2020;3(3):200612.
• 17. Şentürk M, Yavuz Y, Alkan S, Kafadar MT. Investigation of 14 Appendiceal Mucocele Cases Encountered in 4850 Appendectomy Patients. J Gastrointest Cancer. 2021;52(2):701-705.
• 18. Ruiz-Tovar J, Teruel DG, Castiñeiras VM, Dehesa AS, Quindós PL, Molina EM. Mucocele of the appendix. World J Surg. 2007 Mar;31(3):542–8.
• 19-Jose T, Rajesh PS. Appendicitis Inflammatory Response Score in Comparison to Alvarado Score in Acute Appendicitis. Surg J (N Y). 2021;7(3):e127-e131.
• 20-Awayshih MMA, Nofal MN, Yousef AJ. Evaluation of Alvarado score in diagnosing acute appendicitis. Pan Afr Med J. 2019;34:15.
• 21-Canbak T, Acar A. Does alvarado score reduce the need for ultrasonography in the diagnosis of acute appendicitis?. Niger J Clin Pract. 2020;23(6):764-767.
• 22- Kundiona I, Chihaka OB, Muguti GI. Negative appendicectomy: evaluation of ultrasonography and Alvarado score. Cent Afr J Med. 2015;61(9-12):66-73.
• 23. Kehagias I, Zygomalas A, Markopoulos G, Papandreou T, Kraniotis P. Diagnosis and Treatment of Mucinous Appendiceal Neoplasm Presented as Acute Appendicitis. Case Rep Oncol Med. 2016 ;2016.
• 24. Puvaneswary M, Proietto A. Mucocele of the appendix with magnetic resonance imaging findings. Australas Radiol 2006;50(1):71–4.
• 25. Lien WC, Huang SP, Chi CL, et al. Appendiceal outer diameter as an indicator for differentiating appendiceal mucocele from appendicitis. Am J Emerg Med. 2006;24(7):801–5.
• 26. Saylam B, Güldoǧan CE, Coşkun F, Vural V, Çomçali B, Tez M. Distinguishing between acute appendicitis and appendiceal mucocele: Is this possible preoperatively? Eur J Trauma Emerg Surg. 2013;39(5):523–9.
• 27. Abuoğlu H, Yıldız MK, Kaya B, Odabaşı M. Clinical and pathological analysis of patients operated for appendiceal mucocele. Ulus Journal of Trauma and Emergency Surgery 2017 ;23(3):230–4.