Management of Acute Abdomen: Acute Appendicitis

Authors

  • B. R. Neupane Gandaki Medical College and Teaching Hospital, Pokhara, Nepal
  • S. R. Paudel Fewa City Hospital, Pokhara, Nepal
  • A. Shrestha Gandaki Medical College and Teaching Hospital, Pokhara, Nepal
  • S. `M. Bijukchhe Gandaki Medical College and Teaching Hospital, Pokhara, Nepal
  • A. Bhattarai Gandaki Medical College and Teaching Hospital, Pokhara, Nepal
  • P. Subedi Gandaki Medical College and Teaching Hospital, Pokhara, Nepal

DOI:

https://doi.org/10.3126/jgmcn.v12i2.27149

Keywords:

Acute abdomen, Appendicitis, Appendectomy

Abstract

 Background: Traditionally, appendectomy has been the treatment of choice for acute appendicitis but many times diagnosis can be difficult. Clinicians are looking through different ways to come to the correct diagnosis to decrease negative appendectomy. The aim of this study was to determine relation between clinical pattern, laboratory and ultrasonography findings with histopathological report of appendectomy specimen and to evaluate the Alvarado scoring regarding its usefulness in the early diagnosis in our set up.

Methods: Prospective cross-sectional study was carried out in Gandaki Medical College Teaching Hospital and Fewa City Hospital from Jan 1, 2016 to Dec 31, 2018 on consecutively admitted patients with clinical diagnosis of acute appendicitis with study variables as demography, Alvarado score, radiological/laboratory investigations, surgical management, histopathology, and clinical outcome.

Results: Among 1021 patients (48.8% men, 51.2% women), patients with Alvarado score offive and more (967, 88.8%) had abdominal USG and some (134) with score of 5-6 (13.12%) had CT scan. On the basis which 818patients (151 patients with score 5-6 and 667 with score 7 to 10) underwent emergency appendectomy; 705 (86.19%) by open and 113 (13.81%) by laparoscopic technique. Appendicitis was suggestive per-operatively in 76.2% of patients with Alvarado score of 5-6 and 97.4% of patients with the score of 7-10. Histo-pathologically diagnosis was correct in 752 (91.9%), 91.2% in open appendectomy and 96.5% in laparoscopic appendectomy cases. Only two patients had infective complication and no mortality.

Conclusion: Alvarado scoring in patients presenting with acute abdominal pain is reliable predicting tool for acute appendicitis.

Downloads

Download data is not yet available.
Abstract
540
pdf
458

Author Biographies

B. R. Neupane, Gandaki Medical College and Teaching Hospital, Pokhara, Nepal

Lecturer

S. R. Paudel, Fewa City Hospital, Pokhara, Nepal

Consultant Surgeon

A. Shrestha, Gandaki Medical College and Teaching Hospital, Pokhara, Nepal

Lecturer

S. `M. Bijukchhe, Gandaki Medical College and Teaching Hospital, Pokhara, Nepal

Lecturer

P. Subedi, Gandaki Medical College and Teaching Hospital, Pokhara, Nepal

Medical officer

References

Addiss DG, Shaffer N, Fowler BS, Tauxe RV. The epidemiology of appendicitis and appendectomy in the United States. Am J Epidemiol. 1990;132:910–25.

Blomqvist P, Ljung H, Nyren O, Ekbom A. Appendectomy in Sweden 1989–1993 assessed by the Inpatient Registry. J Clin Epidemiol. 1998;51:859–65.

McBurney C. Experiences with early operative interference in cases of disease of the vermiform appendix. NY Med J. 1889;50:1676–84.

Fitz RH: Perforating inflammation of the vermiform appendix. Am J Med Sci. 1886;92:321–46.

Flum DR, Koepsell T. The clinical and economic correlates of misdiagnosed appendicitis Nation-wide analysis. Arch Surg. 2002;37(7):799-804.

Vons C. Diagnosis of appendicular syndromes: for a rational approach. J Chir (Paris). 2001 Jun;138(3):143- 5.

Horton MD, Counter SF, Florence MG, Hart MJ. A prospective trial of computed tomography and ultrasonography for diagnosing appendicitis in the atypical patient. Am J Surg. 2000;179:379–81.

Pinto Leite N, Pereira JM, Cunha R, Pinto P, Sirlin C. CT evaluation of appendicitis and its complications: Imaging techniques and key diagnostic findings. AJR Am J Roentgenol. 2005;185:406–17.

Alvarado A. A practical score for the early diagnosis of acute appendicitis. Ann Emerg Med. 1986;15:557–64.

Gomes CA, Sartelli M, Di Saverio S, Ansaloni L, Catena F, Coccolini F, et al. Acute appendicitis: Proposal of a new comprehensive grading system based on clinical, imaging and laparoscopic findings. World J Emerg Surg. 2015;10:60.

Flum DR, Morris AKoepsell T, Dellinger EP. Has diagnostic accuracy in appendicitis improved with time? JAMA. 2001;286:1748- 53.

Korner H, Sondenaa K, Soreide JA, Andersen E, Nysted A, Lende TH et al. Incidence of acute nonperforated and perforated appendicitis: Age-specific and sex-specific analysis. World J Surg. 1997;21: 313- 7

Lee SL, Walsh AJ, Ho HS. Computed tomography and ultrasonography do not improve and may delay the diagnosis and treatment of acute appendicitis. Arch Surg. 2001;136:556- 62

Pittman-Waller VA, Myers JG, Stewart RM, Dent DL, Page CP, Gray GA et al. Appendicitis: why so complicated? Analysis of 5755 consecutive appendectomies. Am Surg. 2000; 66548- 554.

Sartelli M, Baiocchi GL, Di Saverio S, Ferrara F, Labricciosa FM, Ansaloni L, et al. Prospective observational study on acute appendicitis Worldwide (POSAW). World J Emerg Surg. 2018;13:19.

Bhattacharjee PK, Chowdhury T, Roy D. Prospective evaluation of modified Alvarado score for diagnosis of acute appendicitis. J Indian Med Assoc. 2002 May; 100(5):310-4.

Andersson M, Andersson RE. The appendicitis inflammatory response score: a tool for the diagnosis of acute appendicitis that outperforms the Alvarado score. World J Surg. 2008;32:1843–9.

Bennet J, Boddy A, Rhodes M. Choice of approach for appendectomy: A meta-analysis of open versus laparoscopic appendectomy. Surg Laparosc Endosc Percutan Tech. 2007;17:245–55.

Liu Z, Zhang P, Ma Y, Chen H, Zhou Y, Zhang M, et al. Laparoscopy or not: A meta-analysis of the surgical effects of laparoscopic versus open appendectomy. Surg Laparosc Endosc Percutan Tech. 2010;20:362– 70.

Sauerland S, Jaschinski T, Neugebauer EA. Laparoscopic versus open surgery for suspected appendicitis. Cochrane Database Syst Rev. 2010;10:CD001546.

Wei B, Qi CL, Chen TF, Zheng ZH, Huang JL, Hu BG, et al. Laparoscopic versus open appendectomy for acute appendicitis: a meta-analysis. Surg Endosc. 2011;25:1199–208.

Ohtani H, Tamamori Y, Arimoto Y, Nishiguchi Y, Maeda K, Hirakawa K. Meta-analysis of the results of randomized controlled trials that compared laparoscopic and open surgery for acute appendicitis. J Gastrointest Surg. 2012; 16: 1929–39.

Bradley EL 3rd, Isaacs J. Appendiceal abscess revisited. Arch Surg. 1978;113: 130–2.

Bagi P, Dueholm S. Nonoperative management of the ultrasonically evaluated appendiceal mass. Surgery. 1987; 101:602–5.

Corfield L. Interval appendectomy after appendiceal mass or abscess in adults: what is “best practice”? Surg Today. 2007; 37:1–4.

Sartelli M, Viale P, Koike K, Pea F, Tumietto F, van Goor H, et al. WSES consensus conference: guidelines for first-line management of intra-abdominal infections. World J Emerg Surg. 2011;6:2.

Laurell H, Hansson LE. Gunnarsson U. Manifestations of acute appendicitis: A prospective study on acute abdominal pain. Dig Surg. 2013;30:198-206.

Downloads

Published

2019-12-31

How to Cite

Neupane, B. R., Paudel, S. R., Shrestha, A., Bijukchhe, S. `M., Bhattarai, A., & Subedi, P. (2019). Management of Acute Abdomen: Acute Appendicitis. Journal of Gandaki Medical College-Nepal, 12(2), 3–9. https://doi.org/10.3126/jgmcn.v12i2.27149

Issue

Section

Original Articles