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Acute appendicitis is one of the most common pediatric surgical emergencies with a lifetime risk of approximately 8%, peaking between 10 and 15 years of age. Although it is a common illness, the exact pathophysiology of acute appendicitis remains somewhat unclear. Historically, acute appendicitis was considered to be an irreversible progressive disease starting with mild inflammation, but it will progress to necrosis, perforation and peritonitis over time. Early intervention (removal of the appendix) was therefore warranted. Recently, we rather endorse the idea that two different forms of acute appendicitis exist: uncomplicated (or simple) and complicated (or complex) appendicitis. Each form has its own clinical presentation, epidemiology, most likely pathophysiology, and also maybe treatment strategy. As both diagnostic work-up and treatment of acute appendicitis can be challenging, particularly in the pediatric population, further research on this topic is essential to improve the clinical care of these patients.
This special issue of
Over the past few years several biomarkers obtained from preoperative serum samples have been proposed as predictors of clinical outcomes.
Abscess formation after appendectomy is a rather typical postoperative complication.
These articles can be the base for further research and the optimal treatment of acute uncomplicated (simple) appendicitis in the pediatric population is under vigorous investigation. Hopefully in the next couple of years, the results of the ongoing randomized controlled trials on this topic in the pediatric population will be published. Essential for the success of non-operative treatment strategy is the accurate selection of children with uncomplicated appendicitis. To achieve accurate selection, the exact pathogenesis between uncomplicated and complicated appendicitis needs to be elucidated, and there is still work for better diagnostics as well. Understanding why one child develops an uncomplicated appendicitis while the other develops a complicated one will help us in identifying the most specific biomarkers that can be used in the near future for accurate selection. Integration of novel techniques (proteomics, metabolomics, and artificial intelligence) may even accelerate it.
We hope readers enjoy themselves with this special issue on pediatric appendicitis.
This editorial has been written with equal contribution of all authors. All authors contributed to the article and approved the submitted version.
The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.