Remzi KIZILTAN, Iskan ÇALLI, Ali Rıza KARAYIL, Abbas ARAS, Mehmet Çetin KOTAN

Are Appendix Weight and Length Related to Inflammatory Parameters and Alvarado Score in Acute Appendicitis?

We aimed to investigate if appendix weight and length affects clinical presentation. This study prospectively enrolled 50 patients who were operated with the diagnosis of acute appendicitis. The appendix material was weighed in milligram. Then, the diameter of the appendix was measured in millimeter from its widest point using a surgical ruler. The length of the appendix was measured in millimeter using the same ruler. As appendix length may have influenced its weight, weight in milligram per millimeter was used for standardization. The obtained value was expressed as the unit weight (mg/mm). In order to make a comparison by the obtained unit weight, the patients were divided into two groups. Among 50 patients enrolled in the present study, 24 (48%) were men and 26 (52%) were women. The mean CRP level of the study population was 29.4 (3-160). The mean appendix diameter measured with ultrasonography at the preoperative period was 8.49 mm (range 6-13 mm), and the mean appendix diameter measured with a ruler at the postoperative period was 10.3 mm (range 8-20 mm). There was approximately a 2 mm difference between these measurements which were made from the widest points. In conclusion, it was found that the unit weight of the appendix increased proportionally to the CRP level. The appendix would be more edematous, have a greater diameter and weight, and be more likely to perforate in patients with a higher unit weight.

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1. Graffeo CS, Counselman FL. Appendicitis. Emerg Med Clin North Am 1996; 14: 653-671.

2. Rafiq MS, Khan MM, Khan A, Ahmad B. Total leukocyte and neutrophil count as preventive tools in reducing negative appendectomies. Ulus Travma Acil Cerrahi Derg 2015; 21: 102-106.

3. Yeşiltaş M, Karakaş DÖ, Gökçek B, Hot S, Eğin S.Can Alvarado and Appendicitis Inflammatory Response scores evaluate the severity of acute appendicitis? Ulus Travma Acil Cerrahi Derg 2018; 24: 557-562.

4. Liang MK, Anderson RE, Jaffe MB, Berger DH. Apendiks. In: Schwartz Cerrahinin İlkeleri. 10th edition. Özmen M.Mahir, editör. Güneş Tıp Kitap Evleri, 2014: 1245-46.

5. Özsoy Z, Yenidoğan E. Evaluation of the Alvarado scoring system in the management of acute appendicitis.T urk J Surg 2017; 33: 200-204.

6. Bhangu A, Søreide K, Di Saverio S, Assarsson JH, Drake FT. Acute appendicitis: modern understanding of pathogenesis, diagnosis, and management. The Lancet 2015; 386: 1278-1287. 7. Ahmad KA, Ideris N, Aziz SHSA. A Cross-Sectional Study of Neutrophil-to-Lymphocyte Ratio in Diagnosing Acute Appendicitis in Hospital Melaka. Malays J Med Sci 2019; 26: 55-66.

8. Mostbeck G, Adam E, Nielsen M, Claudon M, Clevert D, Nicolau C, et al. How to diagnose acute appendicitis: ultrasound first. Insights Imaging 2016; 7: 255-263.

9. Association of Surgeons of Great Britain and Ireland. Royal College of surgeons Advancing Surgical Standards. Commissioning Guide: Emergency general surgery (acute abdominal pain). London: Association of Surgeons of Great Britain and Ireland; 2014

10. Tames AC, Yamauchi FI, Castro ADAE, Amoedo CDM, Cardoso EF, Baroni RH, et al. Morphologic criteria of vermiform appendix on computed tomography and a possible risk of developing acute appendicitis. Radiol Bras 2019; 52: 217-221.

11. Ekici U, Tatli F, Kanlioz M. Is the appendix length/diameter ratio an early-indicator for the perforation in acute appendicitis? Annals of Medical Research 2018; 25: 390-393.

12. Delibegović S, Mehmedović Z. The Influence of the Appendiceal Base Diameter on Appendix Stump Closure in Laparoscopic Appendectomy. World J Surg 2016; 40: 2342-2347.

13. Tanrıkulu Y, Yılmaz G, Şen Tanrıkulu C, Temi V, Köktürk F, Çağsar M, et al. A prospective clinical study of the effects of the physical features of the appendix on perforation. Ulus Travma Acil Cerrahi Derg 2015; 21: 440-445.

14. Mohammadi S, Hedjazi A, Sajjadian M, Rahmani M, Mohammadi M, Moghadam M. D. Morphological variations of the vermiform appendix in Iranian cadavers: a study from developing countries. Folia Morphol 2017; 76: 695-701.

15. Memon AA, Vohra LM, Khaliq T, Lehri AA. Diagnostic accuracy of Alvarado score in the diagnosis of acute appendicitis. Pak J Med Sci 2009; 25: 118-121.

16. Armstrong J, Merritt N, Jones S, Scott L, Bütter A. Non-operative management of early, acute appendicitis in children: Is it safe and effective? J Pediatr Surg 2014; 49: 782-785.

17. Özozan ÖV, Vural V. High C-reactive protein level as a predictor for appendiceal perforation.Ulus Travma Acil Cerrahi Derg 2020; 26: 63-66.

18. Ahmed N. C-Reactive Protein: An Aid For Diagnosis Of Acute Appendicitis. J Ayub Med Coll Abbottabad 2017; 29: 250-253.

19. Ahmad KA, Ideris N, Aziz SHSA. A Cross-Sectional Study of Neutrophil-to-Lymphocyte Ratio in Diagnosing Acute Appendicitis in Hospital Melaka. Malays J Med Sci 2019; 26: 55-66.

20. Chung WS, Lin CL, Hsu CY. Women who had appendectomy have increased risk of systemic lupus erythematosus: a nationwide cohort study. Clin Rheumatol 2018; 37: 3009-3016.

21. Piovani D, Danese S, Peyrin-Biroulet L, Nikolopoulos GK, Lytras T, Bonovas S. Environmental Risk Factors for Inflammatory Bowel Diseases: An Umbrella Review of Meta-analyses.Gastroenterology 2019; 157: 647-659.e4.

22. Beecher SM, Hogan J, O’’Leary DP, McLaughlin R. An Appraisal of Inflammatory Markers in Distinguishing Acute Uncomplicated and Complicated Appendicitis. Dig Surg 2016; 33: 177-181.

23. Abongwa HK, Cervellin G, Tarasconi A, Perrone G, Baiocchi G, Portolani N, et al. Antibiotics alone for uncomplicated acute appendicitis in high operative risk adult patients: Analytical review of RCTs and proposal of evidence based treatment decision. Acta Biomed 2016; 87: 334-346.