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Distinguishing fecal appendicular peritonitis from purulent appendicular peritonitis

  • M. Mariage
    Affiliations
    Department of Digestive Surgery, Amiens University Medical Center, Amiens, France

    Jules Verne University of Picardie, Amiens, France
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  • C. Sabbagh
    Affiliations
    Department of Digestive Surgery, Amiens University Medical Center, Amiens, France

    Jules Verne University of Picardie, Amiens, France

    SSPC (simplification des soins des patients chirurgicaux complexes) research unit, Jules Verne University of PIcardie, Amiens, France
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  • T. Yzet
    Affiliations
    Department of Radiology, Amiens University Medical Center, Amiens, France
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  • H. Dupont
    Affiliations
    Intensive Care Unit, Amiens University Medical Center, Amiens, France

    SSPC (simplification des soins des patients chirurgicaux complexes) research unit, Jules Verne University of PIcardie, Amiens, France
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  • A. NTouba
    Affiliations
    Intensive Care Unit, Amiens University Medical Center, Amiens, France
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  • J.M. Regimbeau
    Correspondence
    Corresponding author at: Department of Digestive Surgery, Amiens University Hospital, Avenue Laennec, F-80054 Amiens cedex 01, France.
    Affiliations
    Department of Digestive Surgery, Amiens University Medical Center, Amiens, France

    Jules Verne University of Picardie, Amiens, France

    SSPC (simplification des soins des patients chirurgicaux complexes) research unit, Jules Verne University of PIcardie, Amiens, France
    Search for articles by this author
Published:April 09, 2018DOI:https://doi.org/10.1016/j.ajem.2018.04.014

      Abstract

      Introduction

      Fecal appendicular peritonitis (FAP) is a poorly studied, rare form of acute appendicitis, corresponding to peritoneal inflammation with the presence of feces secondary to ruptured appendix. The purpose of this study was to describe FAP and to compare FAP with purulent appendicular peritonitis (PAP).

      Patients and methods

      This single-center, retrospective study was conducted in consecutive patients to compare the FAP group and the PAP group. The primary endpoint was the 30-day postoperative morbidity and mortality according to the Clavien-Dindo classification. The secondary endpoints were description and comparison of intraoperative data (laparoscopy rate, conversion rate, type of procedure and the mean operating time), and short-term outcomes (types of complications, length of stay, readmission rate, and reoperation rate), comparison of intraoperative bacteriological samples of FAP and PAP as well as the rate of resistance to amoxicillin and clavulanic acid, used as routine postoperative antibiotic therapy.

      Results

      Between January 2006 and January 2016, 2.2% of appendectomies were performed for FAP. Patients of the FAP group reported a longer history of pain than patients of the PAP group (mean: 58 h [range: 24–120] vs 24 h [range: 6–504], p = 0.0001) and hyperthermia was more frequent in the FAP group than in the PAP group (72% vs 26%, p = 0.0001). Mean preoperative CRP was also higher in the FAP group than in the PAP group (110 mg/L [range: 67–468] vs 37.5 mg/L [range: 3.1–560], p = 0.007). Significantly less patients were operated by laparoscopy in the FAP group (89.7% vs 96.6%, p < 0.0001). Mean length of stay was significantly longer in the FAP group than in the PAP group (10 days [range: 3–24] vs 5 days [range: 1–32], p = 0.001). The overall 30-day complication rate was significantly higher in the FAP group than in the PAP group (62.1% vs 24.7%, p = 0.0005). The readmission rate was not significantly different between the two groups (14% vs 11.2%, p = 0.2), but the reoperation rate was higher in the FAP group than in the PAP group (31% vs 11%, p = 0.01). No significant difference was observed between the FAP and PAP groups in terms of the positive culture rate (75.9% vs 65.6%, p = 0.3). No significant difference was observed between the two groups in terms of resistance to amoxicillin and clavulanic acid (18.2% vs 20.5%, p = 0.8).

      Conclusion

      FAP is associated with significantly more severe morbidity compared to PAP. Clinicians must be familiar with this form of appendicitis in order to adequately inform their patients.

      Keywords

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