Study of outcomes of perforated appendicitis in adults: a prospective cohort study

Abstract

Introduction: Acute appendicitis remains the most common general surgical emergency seen in most hospitals and the most common cause of acute abdomen requiring surgical intervention. Aim: The aim was to study the intraoperative features and postoperative outcomes of appendicular perforation in adults. Objectives: First, to study the incidence, clinical presentation, and complications of perforated appendicitis in a tertiary care hospital. Second, to study morbidity and mortality in an operated case of perforated appendicitis. Materials and Methods: This prospective observational study was conducted at a tertiary care centre in a government setup from August 2017 to July 2019. Data were collected from patients ( N =126) who had an intraoperative finding of perforated appendicitis. The inclusion criteria are as follows: patients over the age of 12 with a perforated appendix, as well as any patients with intraoperative findings like perforated appendicitis, gangrenous perforated appendicitis, or a disintegrated appendix. The exclusion criteria are as follows: all patients with appendicitis below 12 years of age with perforated appendicitis; all patients with appendicitis with intraoperative findings of acute nonperforated appendicitis; and all patients with intraoperative findings of an appendicular lump or mass. Results: Perforation was found in 13.8% of the cases of acute appendicitis in this study. With a mean age of 32.5 years, the most common age of presentation in perforated appendicitis was 21–30 years. The most prevalent presenting symptom in all patients (100%) was abdominal pain, followed by vomiting (64.3%) and fever (38.9%). Patients with perforated appendicitis had a 72.2% complication rate. Peritoneal pollution of more than 150 ml was linked to a 100% increase in morbidity and mortality (54.5%). The mean duration of the hospital stay in patients with a perforated appendix was 7.28±5 days. Surgical site infection (42%) was the most common early complication, followed by wound dehiscence (16.6%), intestinal obstruction (1.6%), and faecal fistula (1.6%). The most common late complications were intestinal obstruction (2.4%), intra-abdominal abscess (1.6%), and incisional hernia (1.6%). The mortality rate in patients with perforated appendicitis was 4.8%. Conclusion: To conclude, prehospital delay was an important factor contributing to appendicular perforation and leading to adverse outcomes. A higher rate of morbidity and prolonged duration of hospital stay were seen in patients with delayed presentation, with features of generalised peritonitis and perforation of the base of the appendix. Delayed presentations in as elderly population with underlying co-morbid conditions associated with severe peritoneal contamination were associated with higher mortality (26%) in perforated appendicitis. Conventional surgery and open procedu...

Atypical Presentation of Appendicitis Leading to Exploratory Laparotomy

“…Acute appendicitis is characterized by classical symptoms including fever, right lower quadrant pain, and a positive McBurney’s sign. It is typically confirmed with elevated inflammatory markers and an ultrasound or CT scan [ 3 , 6 ]. In this case, the atypical manifestation of gastroenteritis symptoms, including persistent nausea, anorexia, and hematochezia, prompted the decision for an exploratory laparotomy and subsequent appendectomy [ 7 , 9 , 10 ].…”

“…A substantial risk factor for the development of appendicitis is a family history [ 5 ]. It is imperative to minimize prehospital delays in the diagnosis and management of appendicitis to mitigate the risk of adverse outcomes and complications, including sepsis, abscesses, perforation, and even mortality [ 6 , 7 ]. In this report, we describe a unique case of appendicitis characterized by atypical symptoms alongside unremarkable laboratory results and imaging findings to bring attention to a clinically skewed scenario that can make the initial diagnosis more complex.…”

Profile of appendicitis patient: epidemiology, clinical, and laboratories evaluation in rural-urban area

“…Other subjects' complaints obtained in this study were nausea (37%), vomiting (25.8%), fever (16.3%), digestive tract problems (diarrhea, constipation, bloating, and flatus difficulty) (9.5%), anorexia (3.3%), and other complaints (3.7%). Other prior studies also stated these complaints [3], [27]. One study reports another unusual complaint, such as scrotal pain and lower extremity edema in appendicitis, that needed additional diagnostic guidance [28].…”

Risk factors associated with negative appendicectomy rates: A retrospective cohort study

“…11,12 There are risks associated with a late diagnosis of AA and perforated appendicitis has a signi cant morbidity. 13 However, negative appendicectomies can also lead to complications, and surgical complications have been reported to be similar in patients undergoing a laparoscopic appendicectomy whether or not they have AA. 14,15 Negative appendicectomy rates (NAR) vary widely.…”