2020 Volume 56 Issue 7 Pages 1061-1067
Purpose: In acute appendicitis with fecalith, the distal end of the cavity of the appendix is considered to be closed. However, the relationship between the fecalith and the bacterial distribution in the appendix has not been adequately clarified. Therefore, we retrospectively examined the correlation between the result of the bacterial culture of smears collected from both the proximal and distal ends of the cavity in the appendix and the existence of fecalith. Then, we discussed the selection of antibacterial drugs in cases with fecalith.
Methods: We examined pediatric patients who underwent immediate laparoscopic appendectomy for acute appendicitis in our department for two years from October 2017 to September 2019. Bacterial culture was performed for each of the swabs inserted into both ends of the appendiceal cavity. The group with a clear fecalith on the image was defined as the Stone Group and the group without it was defined as the Stoneless Group. We analyzed the patient background and the species isolated from colonies obtained by culture. Although most of the detected bacterial species were anaerobic, no significant difference in species was found between the collection sites.
Results: There were 15 patients in the Stone Group and 12 patients in the Stoneless Group. Although the average length of stay was longer in the Stone Group, there was no significant difference in other patient backgrounds. Bacteroides species were isolated more frequently from the distal end than from the proximal end in both the Stone Group and the Stoneless Group. When Bacteroides species were isolated from smears from the distal end in the Stone Group, the stage tended to be gangrenous appendicitis.
Conclusions: Even in cases that have not developed perforation or abscess, Bacteroides species may contribute to the pathogenesis of appendicitis with fecalith. Particularly for perforated appendicitis with fecalith, it may be necessary to select an antibacterial drug that is efficacious against such species.
