BackgroundThis study aimed to evaluate the clinical characteristics, imaging accuracy, and postoperative outcomes of acute appendicitis before and after a major earthquake.MethodsWe retrospectively analyzed 810 appendectomies performed between August 2021 and August 2024, stratified into pre- (n = 436) and post-earthquake (n = 374) groups based on the February 6, 2023, earthquake. The study population was restricted to patients who underwent appendectomy, reflecting the clinical outcomes of an operatively managed cohort. Complicated appendicitis was defined based on the postoperative histopathological examination. Pre- and post-earthquake groups were compared using appropriate statistical tests, and logistic regression analysis was performed to identify the factors associated with complicated appendicitis.ResultsThe incidence of complicated appendicitis did not differ significantly between the pre- and post-earthquake groups (9.1% vs 10.8%, P = .429). Postoperative complications were significantly more frequent in the post-earthquake cohort (P < .001), with a notable increase in Clavien-Dindo Grade II events (19.0% vs 5.3%) despite a higher proportion of ASA I individuals. Regarding laboratory parameters, platelet counts were higher in the post-earthquake group (263.5 vs 247.6 × 10[3]/µL, P = .001), while elevated C-reactive protein levels were the sole independent predictor of complicated appendicitis (OR: 3.98, P = .025).ConclusionThe rates of complicated appendicitis remained stable following the earthquake, confirming the preservation of emergency surgical capacity. However, systemic strain was associated with increased minor postoperative morbidity. In an institution maintaining a primary operative approach, these findings demonstrate that sustaining emergency surgical throughput under disaster conditions entails subtle operational frictions, even when surgical access is fully maintained.

Atraumatic splenic rupture is an extremely rare cause of deterioration in the context of concurrent abdominal pathology. This case report describes rapid deterioration and shock in a mid-50s-year-old man with acute complicated sigmoid diverticulitis 3 days into admission without history of abdominal trauma. This was associated with a rapid haemoglobin (Hb) drop from 119 to 37 g/L, which necessitated activation of the massive transfusion protocol. An atraumatic splenic rupture was subsequently diagnosed on urgent exploratory laparotomy. The patient underwent splenectomy followed by a Hartmann's procedure for treatment of perforated sigmoid diverticulitis. This case highlights the importance of maintaining a broad differential diagnosis and consideration of concurrent pathologies for deteriorating patients with common acute infectious abdominal pathologies, including appendicitis or diverticulitis, as missed diagnosis of atraumatic splenic rupture may be fatal due to profound haemorrhage.

Background: Accurate prediction of hospital length of stay (LOS) in pediatric appendicitis is essential for optimizing resource allocation, guiding discharge planning, and improving patient outcomes. This study aimed to explore the potential of machine learning (ML) models for predicting LOS using clinical and ultrasound features, compare the added value of ultrasound findings, and provide interpretable insights using explainable artificial intelligence (XAI) and Bayesian analysis. Methods: A retrospective cohort of 323 pediatric patients with uncomplicated appendicitis was analyzed from publicly available open-access data from the UCI Machine Learning Repository. Clinical-only and clinical-plus-ultrasound feature sets were used to train Random Forest, XGBoost, and Bayesian Additive Regression Trees (BART) models. Performance was evaluated using mean absolute error (MAE), root mean square error (RMSE), mean absolute percentage error (MAPE), and P20 (percentage of predictions within 20% of actual values) with 95% confidence intervals (CIs) from bootstrap resampling. XAI analysis was employed for model interpretability, with exploratory, hypothesis-generating subgroup analyses and sensitivity analyses conducted across patient demographics and imputation strategies. Results: The Random Forest clinical model achieved the best performance (RMSE: 1.66 days, 95% CI: 1.20-2.15; MAE: 1.08 days, 95% CI: 0.80-1.42; P20: 58.7%, 95% CI: 46.0-69.8), significantly outperforming XGBoost (p = 0.03 for RMSE). BART demonstrated comparable accuracy (RMSE: 1.57 days, 95% CI: 1.21-2.12). SHAP analysis identified absence of peritonitis and appendix diameter as the most influential predictors. Subgroup analysis revealed a potentially better performance in female patients (RMSE: 1.21 days, P20: 75.8%) but poor accuracy for prolonged LOS ≥6 days (RMSE: 4.13 days, P20: 0%). Sensitivity analysis confirmed robustness of imputation (Spearman's rho: 0.782-0.927). Conclusions: ML models, particularly Random Forest, predict LOS in pediatric appendicitis using clinical features. XAI provides clinically interpretable insights.

Background Acute appendicitis is one of the most common surgical emergencies and a frequent indication for emergency abdominal surgery. Concerns regarding reduced staffing, competing emergency workload and limited overnight theatre availability have contributed to ongoing debate regarding outcomes following surgery outside routine working hours. Contemporary UK tertiary-centre data remain limited. This study evaluated the association between operative timing, theatre access and short-term clinical outcomes following emergency appendicectomy. Methods A retrospective cohort study was conducted at a UK tertiary centre, including all adults undergoing emergency appendicectomy between January and June 2025. Patients were categorised according to operative start time as in-hours (08:00-17:30) or out-of-hours (17:31-07:59). Data included age, American Society of Anesthesiologists (ASA) Physical Status Classification score, imaging-defined disease severity, time from radiological diagnosis to theatre, length of hospital stay (LOS), postoperative complications and 30-day hospital re-presentations. Continuous variables were assessed for normality using the Shapiro-Wilk test and compared using the Mann-Whitney U test. Categorical variables were compared using Pearson's chi-square test or Fisher's exact test where appropriate. Results A total of 127 patients were included: 69 in-hours and 58 out-of-hours. Mean age was 43.2 ± 18.2 and 44.9 ± 19.3 years, respectively (Mann-Whitney U = 1900.5, p = 0.628). Median ASA score was 2 (interquartile range (IQR) 1-2) in both cohorts (p = 0.686). Imaging-defined complicated appendicitis occurred in 32/69 (46.4%) and 28/58 (48.3%) patients, respectively (p = 0.972). Mean time from radiological confirmation to surgery was 22.9 ± 24.4 hours in-hours and 16.0 ± 14.0 hours out-of-hours (Mann-Whitney U = 2372.0, p = 0.073). Median LOS was 2 (IQR 1-4) and 2 (IQR 1-3) days, respectively (p = 0.430). Postoperative complications occurred in 11/69 (15.9%) and 12/58 (20.7%) patients, respectively (p = 0.489), while 30-day hospital re-presentations occurred in 9/69 (13.0%) and 7/58 (12.1%), respectively (p = 0.869). Overall, 23/127 (18.1%) patients experienced at least one postoperative complication; intra-abdominal collection was the most common, occurring in 11/127 (8.7%). Sixteen patients (12.6%) re-presented within 30 days, including seven hospital readmissions and nine Surgical Same Day Emergency Care (SDEC) reviews. Two patients required conversion to open right hemicolectomy for severe complicated appendicitis with caecal involvement. Conclusions No statistically significant differences were observed between in-hours and out-of-hours appendicectomy in time from radiological confirmation to surgery, postoperative complications, LOS or 30-day hospital re-presentation. Within this cohort, no difference in measured short-term outcomes was detected according to operative timing. Larger multicentre studies are required to assess whether these findings are consistent across different emergency surgical settings and to account for theatre availability, staffing and case prioritisation.

Left-sided acute appendicitis (LSAA) is a rare clinical entity, most commonly associated with midgut malrotation (MM) or situs viscerum inversus (SVI). Its atypical presentation poses a significant diagnostic challenge for emergency physicians, radiologists, and surgeons. We report the case of a 53-year-old man who presented with a two-day history of left-sided abdominal pain, fever, and vomiting. Laboratory investigations revealed marked leukocytosis. Abdominal ultrasonography identified an appendix-like structure with surrounding inflammation in the left iliac fossa. Contrast-enhanced computed tomography (CT) of the abdomen confirmed midgut nonrotation, with the ascending colon positioned on the left side and an abnormal superior mesenteric artery-to-vein relationship. The patient underwent open appendectomy through a midline incision. Intraoperative findings confirmed LSAA with large bowel nonrotation. The postoperative course was complicated by peritonitis, which was managed with surgical intervention and broad-spectrum antibiotics. At the 21-day follow-up, the patient was asymptomatic. This case highlights the importance of maintaining a high index of suspicion for LSAA in patients presenting with atypical left lower quadrant pain. Thorough preoperative imaging, particularly CT, is essential for accurate diagnosis and operative planning. Prompt surgical management remains the cornerstone of treatment to prevent life-threatening complications.

Meralgia paresthetica (MP) is a mononeuropathy caused by compression of the lateral femoral cutaneous nerve (LFCN), producing pain, numbness, and paresthesia over the anterolateral thigh. While MP is commonly due to benign compressive or metabolic causes, it may rarely result from structural lesions such as LFCN schwannomas. We report a 50-year-old woman with a one-month history of right lower quadrant abdominal pain and anterolateral thigh numbness, followed by cramping pain extending into the right leg. She also described a burning sensation in both soles. Examination revealed right iliac fossa tenderness with a positive psoas sign and sensory loss over the anterolateral thigh. Initially, a diagnosis of retrocecal appendicitis was considered. The straight leg raising test was negative, but leg elevation reproduced pain in the right iliac fossa, and neurodynamic testing (LFCN stretch test) reproduced pain over the lateral thigh. Imaging showed a dumbbell-shaped lesion along the right psoas muscle. Laparoscopy confirmed a multilobulated mass in direct continuity with the LFCN, which was completely excised, and the nerve was preserved. Histopathology confirmed a benign schwannoma with degenerative changes. At one month's follow-up, her abdominal pain had resolved, and thigh numbness had improved, though bilateral sole burning persisted and remained unexplained. This case highlights LFCN schwannoma as a rare structural cause of MP that can mimic chronic appendicitis, and it underscores the need to consider structural causes in refractory or atypical thigh pain with abdominal symptoms. It is also important to use imaging and histopathology for timely diagnosis and surgical management.