Appendicitis : Clinical judgement and operative findings

Introduction Appendicitis is the most common intraabdominal disorder that requires emergency surgery, with a 6% lifetime risk. At the end of 20th Century, appendicitis still remains a clinical entity and an ongoing diagnostic dilemma as the presentation may be atypical. Recent literature reports rates of normal appendix removal ranging from 9% to 40%. These results are not different from earlier reports of negative appendix removal between 15% to 35%. In these cases signs of acute inflammation are absent. Some researchers suggest that inflammatory reactions, which might also involve epithelial cells and neuroproliferation, may cause chronic or repeated attacks of acute pain. Furthermore some classes of neuropeptides, such as Substance P (SP) and Vasoactive Intestinal Peptide (VIP) are involved in pain generation. Perforation rates range from 11% to 32%. Delay in diagnosis and treatment is associated with more advanced stages of disease. However, delay in patient consultation leads to perforation, whereas physician-related delay has little or no influence on the incidence of complicated appendicitis. Despite new adjuncts in the evaluation the patients with a suspected diagnosis of appendicitis, (Ultrasonography, Complete Blood Count and Urinalysis) there is no difference in perforation or negative appendectomy rates. Aims and objectives In the present study we tried to evaluate (1} The clinical performance of Physician and Surgeons (With limited adjunctive diagnostic modalities} with histological findings in relation to suspected appendicitis and (2) The factors associated with complicated appendicitis. Materials and methods 412 consecutive appendectomy cases with suspected appendicitis, were reviewed from March 1997 to December 1999, from Department of Surgery, Medicine, Gynaecology as well as from General practice. Demographic data (Age, Gender), Symptoms (Fever, Nausea, Vomiting, Anorexia, Diarrhoea, Constipation, Dysuria), Clinical signs (Temperature, Pulse, Rebound tenderness, Peristalsis) and white blood cell count were collected. The results of ultrasonography, if done, was obtained. The 1. Dr. S.M Amjad Hossain, FCPS (Surgery), Senior Consultant, Dept. of Surgery, Shaheed Suhrawardy Hospital, Dhaka 2. Dr. AKM Mujibur Rahman, FCPS (M); MD (Card), Senior Consultant, Department of Medicine, Shaheed Suhrawardy Hospital Dhaka. 3. Dr. Khairun Nahar, FCPS (Gynae), Medical Officer, Dept. of Obst. and Gynae, Shaheed Suhrawardy Hospital, Dhaka. 4. Dr. Jawharlal Sen, FCPS (Surgery), Associate Surgeon, Dept. of Surgery, Shaheed Suhrawardy Hospital. Dhaka. 5. Dr. Ferdous Mahal, FCPS (Gynae); MS (Gynae), Asstt. Prof., Dept. of Obst. and Gynae, Shahid Monsur Ali Medical College. 6. Dr. Sharmin Rahman, FCPS (Gynae), Senior Consultant, Dept. of Obst. and Gynae, Shaheed Suhrawardy Hospital, Dhaka. 7. Dr. Proddut Kumar Shaha, MBBS, Medical Officer, Dept. of Surgery, Shaheed Suhrawardy H spital, Dhaka.