{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,10]],"date-time":"2026-09-10T05:50:28Z","timestamp":1789019428949,"version":"build-2803163510"},"reference-count":33,"publisher":"MDPI AG","issue":"14","license":[{"start":{"date-parts":[[2024,7,16]],"date-time":"2024-07-16T00:00:00Z","timestamp":1721088000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background\/Objectives: In patients diagnosed with uncomplicated acute appendicitis (UAA), the absence of calcified deposits or stones, called appendicoliths, often leads to consideration of non-operative treatment (NOT), despite the notable treatment failure rate associated with this approach. Previous research has indirectly estimated the prevalence of appendicoliths to range between 15% and 38% retrospectively by CT scan, intraoperative palpation, and pathology report, thereby potentially missing certain concrements. Our hypothesis proposes that this reported prevalence significantly underestimates the occurrence of appendicoliths, which could explain the high failure rate of 29% of patients with appendicitis observed with NOT. Methods: In our prospective study, conducted with a cohort of 56 adult patients diagnosed with acute appendicitis (AA), we employed intraoperative extracorporeal incisions of the vermiform appendix, in addition to standard diagnostic methods. Results: Our findings revealed 50% more appendicoliths by intraoperative incision (n = 36, p &lt; 0.001) compared to preoperative imaging (n = 24). Appendicoliths were present in 71.4% (n = 40, p &lt; 0.001) of AA patients. Conclusions: These results suggest that conventional diagnostic procedures plausibly underestimate the actual prevalence of appendicoliths, potentially elucidating the frequent treatment failures observed in NOT approaches applied to patients with UAA.<\/jats:p>","DOI":"10.3390\/jcm13144166","type":"journal-article","created":{"date-parts":[[2024,7,17]],"date-time":"2024-07-17T12:29:43Z","timestamp":1721219383000},"page":"4166","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["Hidden Appendicoliths and Their Impact on the Severity and Treatment of Acute Appendicitis"],"prefix":"10.3390","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0303-1342","authenticated-orcid":false,"given":"Maximilian","family":"D\u00f6lling","sequence":"first","affiliation":[{"name":"Department of General, Visceral, Vascular and Transplant Surgery, University Hospital Magdeburg, 39120 Magdeburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6708-6596","authenticated-orcid":false,"given":"Mirhasan","family":"Rahimli","sequence":"additional","affiliation":[{"name":"Department of General, Visceral, Vascular and Transplant Surgery, University Hospital Magdeburg, 39120 Magdeburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-8358-6903","authenticated-orcid":false,"given":"Jonas","family":"Pachmann","sequence":"additional","affiliation":[{"name":"Department of General, Visceral, Vascular and Transplant Surgery, University Hospital Magdeburg, 39120 Magdeburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Malik","family":"Szep","sequence":"additional","affiliation":[{"name":"Department of General, Visceral, Vascular and Transplant Surgery, University Hospital Magdeburg, 39120 Magdeburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sara","family":"Al-Madhi","sequence":"additional","affiliation":[{"name":"Department of General, Visceral, Vascular and Transplant Surgery, University Hospital Magdeburg, 39120 Magdeburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mihailo","family":"Andric","sequence":"additional","affiliation":[{"name":"Department of General, Visceral, Vascular and Transplant Surgery, University Hospital Magdeburg, 39120 Magdeburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6021-1841","authenticated-orcid":false,"given":"Ulf D.","family":"Kahlert","sequence":"additional","affiliation":[{"name":"Molecular and Experimental Surgery, Department of General, Visceral, Vascular and Transplant Surgery, Faculty of Medicine, University Hospital Magdeburg, Otto-von-Guericke University, 39120 Magdeburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tobias","family":"Hofmann","sequence":"additional","affiliation":[{"name":"Central Emergency Department, University Hospital Magdeburg, Otto-von-Guericke-University, 39120 Magdeburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4972-9866","authenticated-orcid":false,"given":"Michael","family":"Boettcher","sequence":"additional","affiliation":[{"name":"Department of Pediatric Surgery, University Medical Center Mannheim, University of Heidelberg, 68167 Mannheim, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5395-804X","authenticated-orcid":false,"given":"Luis E.","family":"Mu\u00f1oz","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine 3\u2014Rheumatology and Immunology, Universit\u00e4tsklinikum Erlangen, Friedrich-Alexander Universit\u00e4t Erlangen-N\u00fcrnberg (FAU), 91054 Erlangen, Germany"},{"name":"Deutsches Zentrum f\u00fcr Immuntherapie (DZI), Universit\u00e4tsklinikum Erlangen, Friedrich-Alexander Universit\u00e4t Erlangen-N\u00fcrnberg (FAU), 91054 Erlangen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0258-2484","authenticated-orcid":false,"given":"Martin","family":"Herrmann","sequence":"additional","affiliation":[{"name":"Department of Pediatric Surgery, University Medical Center Mannheim, University of Heidelberg, 68167 Mannheim, Germany"},{"name":"Department of Internal Medicine 3\u2014Rheumatology and Immunology, Universit\u00e4tsklinikum Erlangen, Friedrich-Alexander Universit\u00e4t Erlangen-N\u00fcrnberg (FAU), 91054 Erlangen, Germany"},{"name":"Deutsches Zentrum f\u00fcr Immuntherapie (DZI), Universit\u00e4tsklinikum Erlangen, Friedrich-Alexander Universit\u00e4t Erlangen-N\u00fcrnberg (FAU), 91054 Erlangen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3972-1174","authenticated-orcid":false,"given":"Aristotelis","family":"Perrakis","sequence":"additional","affiliation":[{"name":"Department of General, Visceral, Vascular and Transplant Surgery, University Hospital Magdeburg, 39120 Magdeburg, Germany"},{"name":"Iatriko Medical Center, Department of General, Minimally Invasive Surgery and Surgical Oncology, 15125 Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6248-7086","authenticated-orcid":false,"given":"Roland S.","family":"Croner","sequence":"additional","affiliation":[{"name":"Department of General, Visceral, Vascular and Transplant Surgery, University Hospital Magdeburg, 39120 Magdeburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2024,7,16]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1999","DOI":"10.1007\/s00268-021-06077-5","article-title":"The Worldwide Epidemiology of Acute Appendicitis: An Analysis of the Global Health Data Exchange Dataset","volume":"45","author":"Wickramasinghe","year":"2021","journal-title":"World J. 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