Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2022 Apr;104(4):302-307.
doi: 10.1308/rcsann.2021.0213. Epub 2021 Dec 9.

COVID-19 opens the door for right iliac fossa pain treatment pathway

A Ball  1 , A Mansfield  1 , B Taylor  1 , F Sheerin  1 , J Wickins  1 , Z Akhtar  1 , A Bhangu  1 , S Karandikar  1
Affiliations

COVID-19 opens the door for right iliac fossa pain treatment pathway

A Ball et al. Ann R Coll Surg Engl. 2022 Apr.

Abstract

Introduction: The COVID-19 pandemic has increased the risks of surgery and management of common surgical conditions has changed, with greater reliance on imaging and conservative management. The negative appendectomy rate (NAR) in the UK has previously remained high. The aim of this study was to quantify pandemic-related changes in the management of patients with suspected appendicitis, including the NAR.

Methods: A retrospective study was performed at a single high volume centre of consecutive patients aged over five years presenting to general surgery with right iliac fossa pain in two study periods: for two months before lockdown and for four months after lockdown. Pregnant patients and those with previous appendectomy, including right colonic resection, were excluded. Demographic, clinical, imaging and histological data were captured, and risk scores were calculated, stratifying patients into higher and lower risk groups. Data were analysed by age, sex and risk subgroups.

Results: The mean number of daily referrals with right iliac fossa pain or suspected appendicitis reduced significantly between the study periods, from 2.92 before lockdown to 2.07 after lockdown (p<0.001). Preoperative computed tomography (CT) rates increased significantly from 22.9% to 37.2% (p=0.002). The NAR did not change significantly between study periods (25.5% prior to lockdown, 11.1% following lockdown, p=0.159). Twelve (75%) out of sixteen negative appendectomies were observed in higher risk patients aged 16-45 years who did not undergo preoperative CT. The NAR in patients undergoing CT was 0%.

Conclusions: Greater use of preoperative CT should be considered in risk stratified patients in order to reduce the NAR.

Keywords: Appendectomy; Appendicitis; Clinical Decision-Making; Diagnosis; Tomography; X-Ray.

PubMed Disclaimer

Figures

Figure 1
Figure 1
Appendix histology in each study period broken down by sex and age
Figure 2
Figure 2
Appendix histology for risk score and computed tomography (CT) status across both study periods broken down by sex and age
See this image and copyright information in PMC

Similar articles

See all similar articles

References

    1. GlobalSurg Collaborative . Mortality of emergency abdominal surgery in high-, middle- and low-income countries. Br J Surg 2016; 103: 971–988. - PubMed
    1. Bhangu A, Søreide K, Di Saverio Set al. . Acute appendicitis: modern understanding of pathogenesis, diagnosis, and management. Lancet 2015; 386: 1278–1287. - PubMed
    1. Gomes CA, Abu-Zidan FM, Sartelli Met al. . Management of Appendicitis Globally based on Income of Countries (MAGIC) study. World J Surg 2018; 42: 3903–3910. - PubMed
    1. Di Saverio S, Birindelli A, Kelly MDet al. . WSES Jerusalem guidelines for diagnosis and treatment of acute appendicitis. World J Emerg Surg 2016; 11: 34. - PMC - PubMed
    1. Bhangu A. Evaluation of appendicitis risk prediction models in adults with suspected appendicitis. Br J Surg 2020; 107: 73–86. - PMC - PubMed