A Clinicopathological Study of Acute Appendicitis in Eastern India

Abstract

Background: Appendicitis is the most commonly performed emergency abdominal surgery. An accurate and timely diagnosis of acute appendicitis remains a challenge. Objective: This study was performed to determine and correlate between the clinical patterns of acute appendicitis, laboratory and ultrasound findings and pathology found in appendicectomy specimens to help timely diagnosis and reduce negative appendicectomy rate. Methods: This is a cross sectional study, detailed history and clinical examination of the patient was carried out at the time of admission. Operative findings along with any complications as well as histopathological findings were recorded. Patients were followed up for one month for any complications. Results: A total of 125 patients were treated for appendicitis during this period with a male female ratio of 1:1.36. Most common age group was the 2 nd decade with mean age being 20 years, while most common symptom was abdominal pain. Ultrasonography showed evidence of acute appendicitis in 85.6% and leucocytosis in 66.4% cases. Although only 5.6% of appendices grossly appeared normal during surgery, histopathology showed 14.4% to be normal. Wound sepsis (24.8%) was the most common post-operative complication. Conclusion: Diagnosis of acute appendicitis in our setting is still based on high index of suspicion following clinical evaluation. Combining this with laboratory findings and ultrasound scan has yielded an acceptable negative appendicectomy rate. We advocate routine use of ultrasound along with clinical evaluation and laboratory tests for the timely diagnosis of acute appendicitis and an early surgical intervention to prevent complications.

The Study of Non Operative Treatment for Acute Appendicitis (NOTA)

“…In the present study, pain and tenderness were the most common symptoms present in all patients followed by nausea/vomiting in 61.5% and anorexia in 48.1%. These findings are in accordance with the literature [18][19][20].…”

A clinical study on conservative management of acute appendicitis in a tertiary care centre

“…10 In the present study, abdominal pain was seen in 84% of patients which was contrary to the study conducted by Ekka et al, which was seen in 100% of patients. 13 Anorexia was seen in 90% of patients in the present study, whereas anorexia was seen in 61% of patients in a study by Berry et al 14 87% of patients had nausea/vomiting in this present study, which was similar to a study by Kodliwadmath. 15 45% of patients had fever in this study, but Reddy et al reported fever in 76% of patients in their study.…”

“…16 94% of patients in this study had leukocytosis, but Ekka et al reported leukocytosis in 66.4% of patients in their study. 13 Tenderness in right inguinal fossa was seen in all 100% of patients and rebound tenderness was seen in 34 patients. An eastern Indian study reported tenderness in right inguinal fossa in 89.6% and rebound tenderness in 72.8% of patients.…”

Laparoscopy superseding open appendectomy: a prospective view

“…Ekka et al studied the clinical presentation of 125 patients for a period of 2 years. 6 Alvarado scoring in the evaluation of acute appendicitis was studied by Özsoy et al amongst 156 patients and by Mahesh et al amongst 50 patients. 7,8 The comparison of their findings with our present study is shown in Table 2.…”