A prospective clinical study of the effects of the physical features of the appendix on perforation.

BACKGROUND Acute appendicitis (AA) is one of the most common surgical emergencies, whosepostoperative morbidity and mortality increase significantly when the appendix perforates. The identification of factors that lead to perforation in these patients might effectively reduce morbidity. In this study, factors associated with perforation in AA were examined. METHODS The study included sixty patients divided into equal non-perforated and perforated groups. Preoperative body mass index (BMI) and prehospital delay of the patients, the appendix location, presence of fluid or abscesses during surgery, and the appendix wall thickness, root and end diameters, and length in the surgery specimen were compared. RESULTS The patients were comprised of forty males and 20 females, with a median age of 27 (range 16-84) years. BMI was significantly higher in the perforated group than the non-perforated group (p=0.039). There was no difference between the groups in terms of the presence of fluid (p=0.792); the presence of abscess was higher in the perforated group (p=0.017). The most common location of the appendix was retrocecal in the perforated group (p=0.007). While there was no difference in the appendix end diameter, root diameter was significantly higher in the perforated group (p=0.041), as were wall thickness (p<0.001) and appendix length (p=0.037). CONCLUSION BMI, prehospital delay, a retrocecally positioned appendix, presence of an abscess, and appendix wall thickness, root diameter, and length are risk factors for perforation in AA.