Authors
Sininkina D.V., Vinogradov A.V., Maksimenkov A.V.
Pirogov National Medical and Surgical Center, Moscow
Abstract
Relevance. Appendagitis (torsion of the epiploic appendage) is a rare abdominal disease (0.04–0.3% of all patients with acute abdominal surgery diseases). Most literature sources note that this is a self-limiting condition, requiring primarily conservative treatment. However, cases of serious complications (intra-abdominal abscesses, peritonitis, and intestinal obstruction) have been described, necessitating surgical intervention.
Objective. To analyze literature and our own data, and propose an optimal treatment algorithm for patients with appendicitis.
Patients and Methods. A retrospective analysis of the treatment of 49 patients diagnosed with appendicitis over a 5-year period beginning in 2020, who were admitted to the surgical department of the Pirogov National Medical and Surgical Center. To identify risk factors and propose a treatment strategy for patients with appendagitis, we assessed possible predisposing factors, changes in blood C-reactive protein levels, and the treatment methods used (conservative or surgical).
Results. Initially, surgical treatment was used in two patients (4.1%). Conservative treatment with nonsteroidal anti-inflammatory drugs (NSAIDs) was administered to 47 patients. Of these, 22 patients also received antibacterial therapy. Complications requiring surgical intervention were identified in two patients in the conservative treatment group. No complications were observed in the surgical group. Conservative treatment was associated with a longer hospital stay (5.30±2.74 hospital days with conservative treatment versus 4.00±1.41 hospital days with the initial surgical strategy). Antibacterial therapy was more often used in patients with elevated C-reactive protein (CRP) levels at hospitalization, but its use did not influence management.
Conclusion. The primary diagnostic method for diagnosing appendagitis is abdominal CT scanning. Patients with a confirmed diagnosis of appendagitis are recommended to undergo conservative treatment with NSAIDs. If pain persists and CRP levels increase in the blood within the first two days, surgical treatment is indicated, including diagnostic laparoscopy and removal of the necrotic epiploic appendage. Antibacterial therapy is appropriate for complicated cases with the development of paracolic infiltrate and peritonitis.
Keywords: appendagitis, epiploic appendages, torsion, choice of treatment strategy.
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