Delaying surgery to perform CT scans for suspected appendicitis decreases the rate of negative appendectomies without increasing the rate of perforation nor postoperative complications.

PURPOSE: Negative appendectomies are costly and are embedded with unnecessary risks for the patients. A careful indication for surgery seems mandatory even more so, since conservative therapy emerges as a potential alternative to surgery. The aims of this population-based study were to analyze whether radiological examinations for suspected appendicitis decreased the rate of negative appendectomies without increasing the rate of perforation or worsening postoperative outcomes. METHOD: This study is a retrospective analysis of a prospective population-based database. The data collection included preoperative investigations and intraoperative and postoperative outcomes. RESULTS: Based on 2559 patients, the rate of negative appendectomies decreased significantly with the use of CT scan as compared to clinical evaluation only (9.3 vs 5 %, p = 0.019), whereas ultrasonography alone was not able to decrease this rate (9.3 vs 6.2 %, p = 0.074). Delaying surgery for radiological investigation did not increase the rate of perforation (18.1 vs 19.2 %; adjusted odds ratio (OR) 1.01; 0.8-1.3; p = 0.899). Postoperative complications (surgical reintervention, postoperative wound infection, postoperative hematoma, postoperative intra-abdominal abscess, postoperative ileus) were all comparable. CONCLUSION: In this population-based study, CT scan was the only radiological modality that significantly reduced the rate of negative appendectomy. The delay induced by such additional imaging did not increase perforation nor complication rates. Abdominal CT scans for suspected appendicitis should therefore be more frequently used if clinical findings are unconclusive.

[Thoracopagus symmetricus. On the separation of Siamese twins in the 10th century A. D. by Byzantine physicians]. / Thoracopagus Symmetricus. Zur Trennung von siamesischen Zwillingen im 10. Jahrhundert n. Chr. durch byzantinische Arzte.

The byzantine author, Leon Diakonos, mentions in 974/975 A.D. a pair of "siamese twins", e.g., a thoracopagus symmetricus. He had seen them personally several times in Asia Minor when they were about 30 years old. This pair is possibly the same that was "successfully" surgically separated after the death of one of the twins in the second half of the 10th century in Constantinople. This operation is mentioned by two historiographs, Leon Grammatikos and Theodoros Daphnopates. Although the second twin survived the operation, he died three days later. In spite of its lethal outcome, the operation left a long-lasting impression on the historians of that time and was even mentioned 150 years later by Johannes Skylitzes. Furthermore, the manuscript of Skylitzes, now in the library of Madrid, contains a miniature illuminating this operation. This is likely to be the earliest written report of a separation of siamese twins illustrating the high standard of byzantine medicine of that time.