A study of Burst Appendix, 200 Cases in DMCH

Acute appendicitis is the most common surgical emergency, with16% of the population undergoing appendectomy. Burst appendix is one of the complications of acute appendicitis and occurs 25% cases that is associated with increased morbidity and mortality and hence regarded as a surgical emergency.1 This study focuses on the pattern of presentation, risk factors, accuracy of clinical diagnosis, morbidity and mortality of patients managed for perforated appendicitis in DMCH. This observational study was carried out in the department of surgery, Dhaka Medical College Hospital, Dhaka, from January 2012 to December 2012.Total 200 cases of suspected burst appendicitis were included in this study. Among the 200 cases of suspected burst appendix patients, majority of the cases 48% were of 25 – 34 years age group. Most of the cases 71% were male and 29% were female. Higher income group of patients are less sufferer 8%, origin of pain from umbilicus 74.50% and from RIF 25.50%, nausea in 71.89%, vomiting in 64.05%, anorexia in 32.67%, fever in 50.32%, diarrhea in 5.22% and abdominal distension in 8.49% cases. Tenderness over RIF was present in 100%cases, rebound tenderness was present 80.39% cases, rigidity over RIF was 84.96% patients, Cough test was positive 54.90% cases, Diffuse abdominal tenderness in 87.58% cases, Abdominal distention in 13.07% cases and absent of bowel sound in 40.52% cases. Maximum number of patients reported after 3-4 days of onset of symptoms. Ultrasonogram shows normal findings in 55.56% and suggesting ruptured appendicitis in 44.44% cases. Operative findings of those patients, 33.33% cases presented with only burst appendix without local sequel and 35.29% cases present with generalized peritonitis, 13.73% cases present with localized peritonitis, 10.46% cases present with localized abscess, 5.23% cases present with periappendiceal fluid collection and extraluminal appendolith present in 1.96% cases. Burst appendix present a challenge to the clinicians because it can be delay in diagnosis, result in delay in operation and can be developed fatal complication. So we emphasize on careful history taking and physical examination in such cases can make the difference between life and death.

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Acute Perforated Appendicitis: Clinical Profile and Analysis of Risk Factors

Journal of Nepalgunj Medical College ◽

10.3126/jngmc.v16i2.24865 ◽

2018 ◽

Vol 16 (2) ◽

pp. 13-15

Author(s):

Roman Kidwai ◽

Anup Sharma

Keyword(s):

Risk Factors ◽

Renal Function ◽

Acute Appendicitis ◽

Perforated Appendicitis ◽

Male Dominance ◽

Morbidity And Mortality ◽

Delayed Presentation ◽

Number Of Patients ◽

Purulent Peritonitis ◽

The Common

Introduction: The incidence of complicated acute appendicitis, including perforated or gangrenous appendicitis, remains considerably high (28-29%) despite the availability of modern imaging. Acute perforated appendicitis is associated with increased postoperative morbidity and mortality. The aim of the study was to analyze the clinico-pathological profile and outcomes for suspected perforated acute appendicitis and to determine the factors influencing the risk of perforated appendicitis. Materials and Methods: This was a prospective observational study conducted at Nepalgunj Medical College and Teaching Hospital from November 2016 to August 2018. Patients with suspected appendicle perforation were included. The diagnosis was confirmed atlaparotomy. History, physical findings, biochemical and radiological findings were noted. Results: There were 74 patients. The maximum number of patients were in the age group of 0-20 and 21-40 years with a male dominance (M:F 1.9:1). The common presenting features were pain starting in right iliac fossa and becoming generalized with features of peritonitis. Majority presented late to the hospital with the mean duration of 6.35±2.46 days. 17 (22.97%) patients had deranged renal function test at presentation. All patients underwent laparotomy and appendicectomy. The commonest site of perforation was the tip of appendix (58.08%). 27(52.94%) had generalized purulent peritonitis. All had features of acute appendicitis on histological examination. Of the 75 patients only 17 (22.97%) patients had fecolith. 21 (28.37%) had postoperative complications, commonest being surgical site infection (25.67%). Five (6.67%) patients died after surgery. The common cause of death was septic shock with multiorgan failure. Only one patient died due to myocardial infarction. The complications and mortality were common in those patients whose presentation was late i. e after 72 hours from the onset of symptoms, whose renal function was deranged, age > 60, and who had pyoperitoneum. CONCLUSION: Acute perforated appendix is not uncommon. Males are more common with younger people commonly getting affected. Delayed presentation, pyoperitoneum, age >60 are the common risk factors associated with morbidity and mortality.

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Appendicular perforation and its contributing factors

International Surgery Journal ◽

10.18203/2349-2902.isj20172401 ◽

2017 ◽

Vol 4 (6) ◽

pp. 2007

Author(s):

Anandaravi B. N. ◽

Ramaswami B.

Keyword(s):

Risk Factors ◽

Acute Appendicitis ◽

Elderly Patients ◽

Perforated Appendicitis ◽

Clinical History ◽

The Elderly ◽

Morbidity And Mortality ◽

Delayed Presentation ◽

Contributing Factors ◽

Steroid Dependent

Background: The objective was to study of different risk factors contributing in appendicular perforation and effective management of patients by knowing risk factors.Methods: This study was conducted in the department of general surgery K. R. Hospital Mysore medical college and research institute, Mysore, Karnataka, India from January 2015 to June 2016. Patients of age above 18 years and both sexes operated for acute appendicitis were included in present study. The clinical history, clinical features, investigations, intraoperative findings, were noted and surgical procedure done and all perforated appendicitis cases were operated lower midline incision, through wash given with normal saline drain in situ. Post operatively antibiotics were given and all patients follow up done for one month.Results: Present study duration is one and half year we operated total 100 patients for acute appendicitis. In this study 55 patients were male (55%) and 45 patients were females (45%). According to our study acute appendicitis is more common in males. Appendicular perforation has noticed in 23 female patients. The incidence of perforated appendicitis is low in males 12 out of 35 as compared to females 23 out of 35. The incidence of appendicular perforation is higher in the extreme of ages. In the elderly patients it is 58.33%. Thus, according to present study findings age above (>40 years) is strongly associated with the perforated appendicitis (p<0.001 chi squared test). Delayed presentation shows 77.41% appendicular perforation and faecolith associated with 64.51%.Conclusions: The morbidity and mortality rates are higher in elderly patients, diabetics, steroid dependent and immunocompromised patients. We should be aggressive in the treatment of acute appendicitis associated with high risk factors. So once acute appendicitis is diagnosed, the expedient surgery and appropriate use of perioperative antibiotics can help in reducing the morbidity and mortality.

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Acute Appendicitis: Is There a Difference between Children and Adults?

The American Surgeon ◽

10.1177/000313480607200509 ◽

2006 ◽

Vol 72 (5) ◽

pp. 409-413 ◽

Cited By ~ 12

Author(s):

Steven L. Lee ◽

Hung S. Ho

Keyword(s):

Acute Appendicitis ◽

Pediatric Patients ◽

Age Groups ◽

Wound Infection Rate ◽

Negative Appendectomy ◽

Perforation Rate ◽

Mortality And Morbidity ◽

Delay In Diagnosis ◽

Number Of Patients ◽

History Of

Historically, the lack of classic symptoms and delay in presentation make diagnosing acute appendicitis more difficult in children, resulting in a higher perforation rate. Despite this, the morbidity of acute appendicitis is usually lower in children. We evaluated the current differences in clinical presentation, diagnostic clues, and the outcomes of acute appendicitis between the two age groups. A retrospective review of 210 consecutive cases of pediatric appendectomy and 744 adult cases for suspected acute appendicitis from January 1995 to December 2000. Pediatric patients were defined as being 13 years and younger. Pediatric patients were similar to adult patients with respect to duration of pain before presentation (2.4 ± 4.3 days vs 2.5 ± 7.3 days), number of patients previously evaluated (22.0 vs 17.7%), number of imaging tests (computed tomography or ultrasound; 32.9 vs 40.2%), and number of patients observed (16.7 vs 17.2%). However, pediatric patients required less time for emergency room evaluation (4.0 ± 2.7 hours vs 5.7 ± 4.9 hours, P = 0.0001). In children and adults, a history of classic, migrating pain had the highest positive predictive value (94.2 vs 89.6%), followed by a white blood cell count ≥12 x 109/L (91.5 vs 84.3%). The overall negative appendectomy rate was 10.0 per cent for children and 19.0 per cent for adults (P = 0.003); the perforation rate was 19.0 per cent and 13.8 per cent, respectively (P > 0.05). The perforation rate in children was not associated with a delay in presentation (perforated cases, 2.9 ± 3.3 days compared with nonperforated cases, 2.3 ± 4.6 days). Mortality and morbidity, including wound infection rate and intra-abdominal abscess rate, were similar. Contrary to traditional teaching, diagnosing acute appendicitis in children is similar to that in adults. A history of migratory pain together with physical findings and leukocytosis remain accurate diagnostic clues for children and adults. Perforation rate and morbidity in children is similar to those in adults. The outcomes of acute appendicitis in children are not associated with a delay in presentation or delay in diagnosis.

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Management of Appendicitis

10.5772/intechopen.100338 ◽

2022 ◽

Author(s):

Vishal P. Bhabhor

Keyword(s):

Acute Appendicitis ◽

Acute Abdomen ◽

Medical Management ◽

Surgical Intervention ◽

Life Time ◽

Morbidity And Mortality ◽

Surgical Emergency ◽

First Choice ◽

Common Causes ◽

India And China

Appendicitis is one of the most common causes of acute abdomen with life time risk between 6 and 8% and it’s a most common non obstetric surgical emergency during pregnancy. Appendicitis is claimed to be unknown in the villages of India and China in paper by A. M. Spencer. The reason is simply due to the fact that diagnostic facilities do not exist and cases are not recognized. So diagnosing acute appendicitis accurately and efficiently can reduce morbidity and mortality from perforation and other complications. Surgical intervention is the first choice for appendicitis with medical management being reserved for special situations.

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A study on the role of raised serum bilirubin levels in acute appendicitis and its outcomes

International Surgery Journal ◽

10.18203/2349-2902.isj20191870 ◽

2019 ◽

Vol 6 (5) ◽

pp. 1561

Author(s):

Abhilash Madhavan ◽

Lakshmana Raman

Keyword(s):

Acute Appendicitis ◽

Bilirubin Level ◽

Serum Bilirubin ◽

Elevated Serum ◽

Perforated Appendicitis ◽

Serum Bilirubin Level ◽

Inclusion Criteria ◽

Predictive Capacity ◽

College Hospital ◽

Medical College

Background: Acute appenidictis is the most common general surgical emergency and early surgical intervention improves outcomes. Despite the increased use of ultrasonography, computed tomography and laparoscopy, the rate of misdiagnosis of appendicitis has remained constant (15.3%) as has the rate of appendicular perforation. Thus, elevated serum bilirubin level will help in the early and accurate diagnosis of acute appendicitis and if so does it have the predictive capacity to warn us about appendicular perforation.Methods: In this study 100 patients were selected as per satisfaction of the inclusion criteria. This study was carried out at SRM medical college hospital between July 2017 to October 2018. All the data findings were recorded and were analysed.Results: In this study 100 patients were selected on satisfying the inclusion criteria. The serum bilirubin levels were recorded for all these patients. Based on the study it was found out that the serum bilirubin levels was elevated in majority of the cases of acute appendicitis and markedly elevated in case of perforated appendicitis. Though the results were not statistically significant the study seems to be clinically significant.Conclusions: Serum bilirubin level seems to be a reliable diagnostic marker for predicting acute appendicitis and perforated or gangrenous appendicitis.

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Hyperbilirubinemia as a diagnostic marker for acute appendicitis

International Surgery Journal ◽

10.18203/2349-2902.isj20181977 ◽

2018 ◽

Vol 5 (6) ◽

pp. 2091

Author(s):

Sagar Ramesh Ambre ◽

Shahaji Chavan

Keyword(s):

Acute Appendicitis ◽

Clinical Diagnosis ◽

Diagnostic Marker ◽

Iliac Fossa ◽

Clinical Signs ◽

Research Centre ◽

College Hospital ◽

Alvarado Score ◽

Delay In Diagnosis ◽

Significant Difference

Background: Appendicitis is one of the commonest cause of abdominal pain requiring emergency surgery. Different clinical signs and symptoms always mimic the diagnosis of acute appendicitis with number of causes leading to pain in right iliac fossa, especially in females. Accurate diagnosis can be aided by additional tests. A delay in diagnosis can lead to appendiceal perforation with increased morbidity, and an appendectomy as soon as the condition is suspected, may increase the number of unnecessary appendicectomies. Objective of present study was to evaluate the role of hyperbilirubinemia as a diagnostic marker for Acute Appendicitis.Methods: This is a prospective study of 100 patients carried out at Dr. D.Y. Patil Medical College, Hospital and Research Centre, Pimpri, Pune from May 2015 to September 2017. Patients presenting to surgical OPD with pain in Right iliac fossa will be evaluated. Those with a clinical diagnosis of acute appendicitis will be included in the study.Results: Acute appendicitis is one of the most common emergencies and appendicectomy is one of the most frequently done abdominal operations. Clinical diagnosis using time tested clinical signs is effective in diagnosing appendicitis. However, bilirubin supports diagnosis and hence avoids chances of error in diagnosis. The investigation Bilirubin alone is not sufficient to accurately diagnose acute appendicitis, however the clinical findings, ALVARADO SCORE when combined can predict appendicitis. There is significant difference in total bilirubin in acute and probable cases of appendicitis but it can be used to differentiate both of them. In present study Mean bilirubin for acute appendicitis was 1.23mg/dl and probable cases of appendicitis was 0.84mg/dl, with SD for acute appendicitis was 0.598 and probable cases of appendicitis was 0.486. In our study bilirubin provide the highest diagnostic accuracy for acute appendicitis case. Normal inflammatory markers cannot exclude appendicitis, which remains a clinical diagnosis. The presence of history of pain and or signs of peritoneal inflammation which help you in diagnosing acute appendicitis.Conclusions: Hyperbilirubinemia can be a diagnostic marker for acute appendicitis.

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Perforated Appendicitis with Appendicular Abscess

Anwer Khan Modern Medical College Journal ◽

10.3329/akmmcj.v8i1.31663 ◽

2017 ◽

Vol 8 (1) ◽

pp. 73-75

Author(s):

Md Tahminur Rahman ◽

Abdus Salam Arif ◽

Md Abdul Wohab Khan ◽

Mumtahina Setu ◽

Md Imam Shafique ◽

...

Keyword(s):

Abdominal Pain ◽

Early Diagnosis ◽

Acute Appendicitis ◽

Perforated Appendicitis ◽

Signs And Symptoms ◽

College Hospital ◽

Medical College ◽

Paediatric Department ◽

Life Threatening ◽

History Of

Most patients with acute appendicitis can be easily diagnosed, but there are many in whom the signs and symptoms are quite variable, and a firm clinical diagnosis is often very difficult to establish. Difficulties in the early diagnosis of appendicitis, particularly in children, often lead to life threatening complications, such as gangrene or perforation of the appendix. Here we report a case where a nine-year-old boy presented to the Paediatric Department at Anwer Khan Modern Medical College Hospital in Dhaka in April 2016 with a history of abdominal pain, vomiting & fever that began nine days before admission.Anwer Khan Modern Medical College Journal Vol. 8, No. 1: Jan 2017, P 73-75

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Acute appendicitis severity during the early COVID-19 pandemic period

Trauma Surgery & Acute Care Open ◽

10.1136/tsaco-2021-000809 ◽

2021 ◽

Vol 6 (1) ◽

pp. e000809

Author(s):

Thomas D Zaikos ◽

Elizabeth M Boudiab ◽

Emanuela C Peshel ◽

Annie A Wu ◽

Ethan Dyer ◽

...

Keyword(s):

Acute Appendicitis ◽

Perforated Appendicitis ◽

Late Presentation ◽

Level Of Evidence ◽

Equivalent Time ◽

Number Of Patients ◽

Significant Difference ◽

The Us ◽

Time Periods ◽

Surgical Conditions

BackgroundThe early COVID-19 pandemic period significantly strained the US healthcare system. During this period, consultations and admissions for acute medical conditions decreased, which was associated with an increase in disease-specific morbidity and mortality. Therefore, we sought to determine what, if any, effect the early COVID-19 pandemic period had on the presentation, management, and histopathologic severity of acute appendicitis.MethodsWe performed a retrospective, observational study to compare the frequencies with which patients presented with acute appendicitis, the proportion of whom were managed surgically, and the distribution of histopathologic disease severity among all resected appendix specimens during the early COVID-19 pandemic period (March 6–June 30, 2020) to equivalent time periods for the 3 preceding/pre-pandemic years (2017–2019).ResultsCompared with equivalent pre-pandemic time periods, during the COVID-19 pandemic period there was no significant difference in the number of patients who presented for acute appendicitis, there was a decreased rate of surgical management (81% vs 94%; p=0.014), and there was an overall increase in the incidence of perforated appendicitis (31% vs 16%; p=0.004), including by histopathologic diagnosis (25% vs 11%; p=0.01).DiscussionDespite potential patient hesitancy to present for care, the early COVID-19 pandemic period was associated with no significant change in the number of patients presenting with acute appendicitis; however, there was a significant increase in the incidence of perforated appendicitis. This study highlights the need to encourage patients to avoid late presentation for acute surgical conditions and for the robust planning for the medical management of otherwise surgical abnormalities during episodes of restricted or limited resources.Level of evidenceLevel III.

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Hyperbilirubinemia: a new diagnostic marker for perpendicular perforation

International Surgery Journal ◽

10.18203/2349-2902.isj20173880 ◽

2017 ◽

Vol 4 (9) ◽

pp. 3024

Author(s):

Ramaswami Y. B. ◽

Prakash H. S. ◽

Raghavendra Prabhu T. C. ◽

Faiyaz Abdul Jabbar

Keyword(s):

Acute Appendicitis ◽

Serum Bilirubin ◽

Diagnostic Marker ◽

Clinical Signs ◽

Perforated Appendicitis ◽

Signs And Symptoms ◽

Total Serum Bilirubin ◽

Total Serum ◽

Delay In Diagnosis ◽

Clinical Signs And Symptoms

Background: Appendicitis is one of the commonest causes of abdominal pain requiring emergency surgery. Diagnosing acute appendicitis clinically still remains a common surgical problem as the clinical signs and symptoms of other abdominal pathologic conditions mimic the diagnosis of acute appendicitis. Delay in diagnosis and surgery for this condition may lead to various complications like perforation, abdominal abscess etc. By knowing perforation prior to the exploration, we can manage the condition very effectively in terms explaining the prognosis of disease, morbidity of surgery, wound infection, and requirement of emergent nature of surgery. Aim of the study is to determine of role of hyperbilirubinemia as a new diagnostic marker to predict gangrenous/perforated appendicitis.Methods: It’s a retrospective study was conducted in the department of surgery, MMCRI, Mysore during the period of January 2015 to December 2015 total of 100 patients with clinical as well as ultrasonographic diagnosis of acute appendicitis or appendiceal perforation were made. The serum bilirubin test was carried out in all the patients pre-operatively.Results: In the study, the total 100 patients enrolled for the study, hyperbilirubinemia (> 1.2 mg/dL) in present study was found in 47 patients with 19 acute and 28 patients perforated appendicitis of all the 100 patients while 53 patients had normal bilirubin levels (≤ 1.2 mg/dL) 51 patients acute and 2 patients perforated appendix.Conclusions: Total serum bilirubin appears to be a new promising laboratory marker for diagnosing appendicular perforation. The patients with clinical signs and symptoms of appendicitis and with hyperbilirubinemia without elevation of liver enzymes should be identified as having a higher probability of appendicular perforation, suggesting total serum bilirubin levels have a predictive potential for the diagnosis of appendicular perforation.

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THE INCIDENCE OF PERFORATED APPENDICITIS AMONG PEDIATRIC PATIENTS IN KHARTOUM NORTH TEACHING HOSPITAL, SUDAN

Global Journal of Public Health Medicine ◽

10.37557/gjphm.v1i2.23 ◽

2019 ◽

Vol 1 (2) ◽

pp. 90-95

Keyword(s):

Acute Appendicitis ◽

Teaching Hospital ◽

Pediatric Patients ◽

Iliac Fossa ◽

Perforated Appendicitis ◽

Cross Sectional Study ◽

Cross Sectional ◽

Number Of Patients ◽

Right Iliac Fossa Pain ◽

The Mean

Introduction: Acute appendicitis is a common emergency condition in paediatrics with different ages. The perforated appendicitis is one of the most serious complications of acute appendicitis which may lead to peritonitis. The aim of our study is to calculate the incidence of perforated appendicitis. Methods: This is a retrospective cross-sectional study has been conducted at Khartoum north teaching hospital. The total number of patients was 214. Results: the most common age in this study are 13 years old and the mean age is 11 years, 128 of cases were male 59.8% and 86 were females 40.2%. All cases of our study presented with fever 100%, 80.8% presented with right iliac fossa pain, and anorexia 100%. 50.5% of cases came within the first day of presentation and 26.6% of cases came in 4thday of presentation, all cases presented with right iliac fossa tenderness, 15.9% of cases presented with perforated acute appendicitis, 67.29% of cases operated after 6 hours, 5.61% operated in more than 6 hours and 27.1% operated after 6 weeks. Conclusion: In this study the incidence of perforated acute appendicitis was 15.9% which is low in comparison with another study because there was no delay in appendectomy operation and the majority of patients came within the first day of the disease.

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