A Clinicopathological Review of 324 Appendices Removed for Acute Appendicitis in Durban, South Africa: A Retrospective Analysis

Abstract

INTRODUCTION Acute appendicitis remains a common surgical condition and the importance of specific elements in the clinical diagnosis remain controversial. A variety of neoplastic and inflammatory conditions mimic acute appendicitis. The purpose of this study was to determine the presenting pattern of acute appendicitis and to review the pathological diagnosis. PATIENTS AND METHODS This is a retrospective analysis of 324 patients who had appendicectomy for acute appendicitis at Prince Mshiyeni Memorial Hospital (Natal, South Africa) during the period January 2002 to December 2004. Patient demographics, clinical features, white cell count, operative findings, outcome and histology results were recorded on a special patient proforma. RESULTS A total of 371 patients underwent appendicectomy during this period and 324 (M:F, 3.6:1) were available for analysis. The majority of our patients were in the second decade (43.1%) with only 29.3% presenting within 24 h of onset of symptoms. The most common symptoms were abdominal pain (100%), vomiting (57.4%) and anorexia (49.0%). Generalised and localised abdominal tenderness were present in 62.0% and 19.4% of patients, respectively. Pyrexia was noted in 41.0%. Localised and generalised peritonitis were present in 26.4% and 14.0%, respectively. The most common incisions were lower midline laparotomy (47.2%) and gridiron (37.3%). The negative appendicectomy rate was 17.0%. Acute appendiceal inflammation and gangrenous appendicitis was present in 36.1% and 9.6%, respectively. The perforation rate was 34.0% and there was a direct correlation with delayed presentation. There were no patients with carcinoid tumour or adenocarcinoma. Parasites and other associated conditions were seen in 8.6% of cases. Postoperative complications included: wound sepsis (25.3%), prolonged ileus (6.2%), peritonitis (4.6%) and chest infection (3.4%). Four patients died (1.2%) all from the perforated group. CONCLUSIONS Our patients present late with advanced disease and complications. All surgeons should bear in mind the possibility of parasitic infestations mimicking acute appendicitis and the presence of significant unusual histological findings in our setting justifies routine histopathological examination of appendices.CHAMISA

Negative Appendectomy: an Audit of Resident-Performed Surgery. How Can Its Incidence Be Minimized?

“…One has to use all of his judgment to strike the fine balance between misdiagnosing AA and not denying surgery to a patient of AA. Our NAR is comparable to other studies [14][15][16][17]. Various authors have reported that the highest incidence of NAR occurs in females of the reproductive age group (15-49 years) [5,6,13,18].…”

Clinico-pathological study of appendicitis in a tertiary centre in Vindhya region, Madhya Pradesh, India

“…1 I Chamisa 5 also found majority of patient's incidence of appendicitis in the second decades. 1,5 In our study male female ratio is slightly equal i.e. 1.4:1 but Ashley showed slightly higher incidence in female.…”

“…This include histologically normal appendix with or without the presence of fecolith or parasite in the lumen. 5 We observed incidence of appendicular lesions was 385 (4.28%) out of all surgical admissions (8562). Ashley also found incidence of appendicitis is (12%) in sub population.…”

Role of CA125 in the Diagnosis of Acute Appendicitis

“…If untreated, it may cause complications and mortality. Complicated AA comprises 18-34% of cases (11,12). Main complications are perforation and abscess formation.…”