Evidence map›Paper›PMID 39160081›Full record

Observational studyBMJ open gastroenterology2024

Appendicolith classification: physical and chemical properties of appendicoliths in patients with CT diagnosed acute appendicitis - a prospective cohort study.

Sanja Vanhatalo, Ermei Mäkilä, Antti J Hakanen, Eveliina Munukka, Jarno Salonen, Timo Saarinen, Juha Grönroos, Suvi Sippola, Paulina Salminen

Registry-linked trialAbstract readObservational Study
PubMed Full text at PMC Publisher
In one paragraph

Observational study in BMJ open gastroenterology, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT03257423 (Acute Appendicitis and Microbiota - Ethology of Appendicitis and Effects of the Antimicrobial Treatment - The MAPPAC), which is not on this map. Cited by 4 papers.

0numbers the graph read from it
0cells of the map it votes in
4citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT03257423 naunknown statusnot on this map

Acute Appendicitis and Microbiota - Ethology of Appendicitis and Effects of the Antimicrobial Treatment - The MAPPAC (Microbiology Appendicitis Acuta) Trial

TypeinterventionalSponsorTurku University HospitalRan2017 to 2025Enrolled200ConditionsAcute AppendicitisArmsErtapenem followed by levofloxacin and metronidazole, Moxifloxacin, Appendectomy, Placebo
3 · Its place in the literature

Who cites it

4 citing papers in PubMed.

  1. Article
  2. Appendicitis.Nature reviews. Disease primers · 2025
    Review
  3. Article
  4. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

9 authors.

Sanja VanhataloInstitute of Biomedicine, University of Turku, Turku, Finland.ORCID 0000-0001-6038-1755
Ermei MäkiläDepartment of Physics and Astronomy, University of Turku, Turku, Finland.
Antti J HakanenInstitute of Biomedicine, University of Turku, Turku, Finland.
Eveliina MunukkaInstitute of Biomedicine, University of Turku, Turku, Finland.
Jarno SalonenDepartment of Physics and Astronomy, University of Turku, Turku, Finland.
Timo SaarinenDepartment of Geography and Geology, University of Turku, Turku, Finland.
Juha GrönroosDivision of Digestive Surgery and Urology, TYKS Turku University Hospital, Turku, Finland.
Suvi Sippola *Division of Digestive Surgery and Urology, TYKS Turku University Hospital, Turku, Finland.
Paulina Salminen *Division of Digestive Surgery and Urology, TYKS Turku University Hospital, Turku, Finland paulina.salminen@tyks.fi.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

objectiveAppendicoliths are associated with a more complicated course of acute appendicitis and failure of non-operative treatment. We aimed to update the appendicolith classification originally described in 1966 and to assess the association of appendicolith characteristics with appendicitis severity.

designThis prospective predefined MAPPAC-trial (ClinicalTrials.gov NCT03257423) substudy included patients with CT diagnosed appendicitis presenting with an appendicolith. CT visible appendicoliths were harvested at surgery, measured and characterised by morphological examination complemented with micro-CT and micro-X-ray fluorescence spectroscopy. Patients were categorised into two groups: appendicolith appendicitis without other complications and appendicolith appendicitis with complications (appendiceal gangrene, perforation and/or abscess). The association of appendicolith classification and characteristics with appendicitis severity was evaluated.

resultsOf 78 patients with a CT appendicolith, 41 appendicoliths were collected and classified based on the degree of hardness into three classes. The hardest appendicoliths (class 3) were less common (19.5%) presenting with a stone-hard outer layer and concentrically layered inner structure around a core. The layered inner structure was also observed in class 2 appendicoliths, but was absent in soft, class 1 appendicoliths. Appendicolith hardness or measures (maximum length, diameter and weight) were not associated with appendicitis severity. The spatial distribution of the main inorganic elements of calcium and phosphorus varied within most appendicoliths.

conclusionThis updated classification confirms categorisation of CT visible appendicoliths into three classes based on their physical and chemical characteristics. The data on clinical and aetiopathological characteristics of appendicoliths is scarce and using this systematic classification would add to this understanding.

Indexed as

AppendicitisTomography, X-Ray ComputedAcute DiseaseAdultAgedAppendectomyAppendixCalculiFemaleHumansMaleMiddle AgedProspective StudiesSeverity of Illness IndexYoung AdultABDOMINAL SURGERYAPPENDICITISGASTROINTESTINAL PATHOLOGY

Identifiers

PMID39160081
PMCPMC11337665

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Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.