WSES guidelines for diagnosis and management of acute appendicitis. Dr. Luca Ansaloni Head, General and Emergency Surgery , M. Bufalini Hospital, Cesena AUSL Romagna, Italy 16.5.2019, Mozyr, Belarus

2016

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DIAGNOSIS What is the value of clinical and laboratory findings in pts with suspected appendicitis? decision to do additional imaging of a pt with suspected AA is based mainly on the complaints of the pt combined with findings at physical examination. clinical presentation is seldom typical and diagnostic errors are common: a thorough clinical examination is often stressed as an essential part of diagnosis, with laboratory examinations as an adjunct to the gathered clinical information, but review by Andersson shows that each element of the history and of clinical and laboratory examinations is of weak discriminatory and predictive capacity. However, clinical diagnosis is a synthesis of information obtained from all these sources, and a high discriminatory and predictive power can be achieved by an accurate understanding of the relative importance of variables in combination. When the values of two or more inflammatory variables found in laboratory are normal, appendicitis is unlikely. Conversely, AA is very likely when the values of two or more inflammatory variables are increased. Laboratory tests of the inflammatory response and the clinical descriptors of peritoneal irritation and migration of pain are the strongest discriminators and should be included in the diagnostic assessment of pts with suspected AA.

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THM Take home messages Diagnosis: scores to exclude and stratify for imaging (US, CT) Treatment: NOM in uncomplicated AA vs (laparoscopic) surgery (may wait up to 24 hrs), laparoscopic surgery for complicated AA Antibiotic: Broad sprectrum preop, no postop for uncomplicated, 3-5 days for complicated

thank you for the attention!               luca.ansaloni@auslromagna.it aiace63@gmail.com