Chronic vascular stenosis background of acute appendicitis in
Chronic vascular stenosis: background of acute appendicitis in elderly patients 24735 Sintija Lapsa 1, Ilze Štrumfa 2, Artūrs Ozoliņš 1, Jānis Gardovskis 1 1 Pauls Stradins Clinical University Hospital – Surgery department 2 Riga stradins University Department of pathology Introduction Results Acute appendicitis is one of the most common acute surgical pathologies. Acute appendicitis in elderly patients is still a diagnostic challenge and has higher incidence of perforated appendicitis, this can lead to higher mortality and morbidity rates than general population. Complicated disease is more common in elderly population, due to concomitant diseases including athersoclerosis. After the negative appendectomies were excluded, archive search yielded 53 elderly and 70 young patients subjected to appendectomy for morphologically verified acute appendicitis. Chronic vascular stenosis was found in 12/70 s. 17. 1% [95% confidence interval 9. 9 -27. 8] young patients contrasting with 37/53 s. 69. 8% [56. 480. 6] elderly cases; Fisher’s exact two-tailed p < 0. 0001. In the elderly group, the stenotic changes involved a. appendicularis in 32. 1% [21. 0 -45. 5] cases, mesenteriolar arteries and arterioles in 28. 3% [17. 9 -41. 7] and submucosal vessels in 26. 4% [16. 3 -39. 7]. Among young patients, the appendicular artery was narrowed in 2. 9% [0. 2 -10. 4] cases, mesenteriolar blood vessels in 7. 1% [2. 7 -16. 0] and submucosal arteries and arterioles in 12. 9% [6. 7 -22. 9] cases. Notably, elderly patients were characterised by marked concentric vascular stenosis while focal eccentric stenosis prevailed in younger patients (p < 0. 0001). Aim of the study To assess the presence and type of chronic vascular stenosis in appendicular blood vessels, related to acute appendicitis in elderly patients in comparison to young cases. We hypothesized that chronic vascular lesions can be more frequent in older than in young patients operated for acute appendicitis. 80% Materials and Methods 70% 60% 50% The study was designed by retrospective approach. Consecutive cases of surgically treated and morphologically confirmed acute appendicitis were identified in archives of a single university hospital. Two cohorts of patients were defined by age: young cases, diagnosed with appendicitis at the age between 18 and 35 years, and elderly group, including patients older than 65 years. Presence and type (eccentric versus concentric) of chronic vascular stenosis was evaluated in a. appendicularis, small arteries and arterioles in the mesenteriolum and in submucosal tissues. Descriptive and analytical statistics was carried out by SPSS 23 (IBM); p < 0. 05 was considered significant. 40% 30% 20% 10% 0% Chronic vascular stenosis A. apppendicularis Mesenteriolar arteries Submucosal vessels Younger patients Elderly patients Conclusions Appendicitis in elderly patients is frequently associated with chronic vascular stenosis. Further studies are necessary to assess the pathogenetic significance of this finding.
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