The current management of acute uncomplicated appendicitis: should there be a change in paradigm? A systematic review of the literatures and analysis of treatment performance.

INTRODUCTION: Appendectomy has long been the mainstay of intervention for acute appendicitis, aiming at preventing perforation, peritonitis, abscess formation and recurrence. With better understanding of the disease process, non-operative management (NOM) with antibiotics alone has been proved a feasible treatment for uncomplicated appendicitis. This article aimed at systematically reviewing the available literatures and discussing the question whether NOM should replace appendectomy as the standard first-line treatment for uncomplicated appendicitis. METHOD: A search of the Embase, Pubmed and Cochrane Library was performed using the keywords 'acute appendicitis' and 'antibiotic therapy'. Meta-analysis with inverse variance model for continuous variable and Mantel Haenzel Model for dichotomous variable was performed to evaluate the one year treatment efficacy, morbidities rate, sick leave duration and length of hospital stay associated with emergency appendectomy and NOM. RESULTS: Six randomized control trials were identified out of 1943 publications. NOM had a significant lower treatment efficacy rate at one year, 0.10 (95% CI 0.03-0.36, p < 0.01), when compared to appendectomy. The morbidities rate was comparable between the two interventions. The length of hospital stay was longer, with a mean difference of 1.08 days (95% CI 0.09-2.07, p = 0.03), and the sick leave duration was shorter, a mean difference of 3.37 days (95% CI -5.90 to -0.85 days, p < 0.01) for NOM. CONCLUSION: The paradigm remains unchanged, that appendectomy is the gold standard of treatment for uncomplicated appendicitis, given its higher efficacy rate when compared to NOM.

Beyond the lymph nodes: FDG-PET/CT in primary extranodal lymphoma.

Extranodal lymphoma can be the primary presentation or secondary to systemic involvement of lymphoma. 2-(fluorine-18) fluoro-2-deoxy-d-glucose positron emission tomography with computer tomography (FDG-PET/CT) is useful in detecting extranodal sites during staging, treatment response assessment or recurrence detection in patients with lymphoma. In this article, we reviewed the imaging features and FDG avidity of primary extranodal lymphoma of various organs and systems on FDG-PET/CT, demonstrating the pearls and pitfalls of FDG-PET/CT in evaluating this disease entity and cross-referencing to other imaging modalities that aid in diagnosis and management.