PERFORATED APPENDICITIS STUDY OF THE AFFECTING FACTORS

Abstract

Objective: To study the factors affecting the rate of perforation in patients with acute appendicitis with view of adding to local data and comparing our results with other local and international studies. Patients and Methods: A prospective study carried out on 135 pts. treated by emergency appendicectomy at Al-Sadar Teaching Hospital from June 2003 – 2004, they were divided according to their operative findings, into tow groups, those with acutely inflamed non perforated appendix (109 pts.) and those with perforated appendix (26 pts.). All the data collected were analyzed using Z-test. Results: The highest incidence of acute appendicitis (non perforated and perforated) was in the age group 21-30 years (52 pts.; 38.5%), while the lowest incidence was in the age group below 10 years (8 pts.; 5.9%) and above 60 years (6 pts.; 4.4%), in addition ,the highest incidence of perforation was in the age group over 60 years (3 pts.; 50%) and below 10 years (3 pts.; 37.5%),while, the lowest incidence was in the age group 21-30 years (5 pts.; 9.6%),however, the overall incidence of perforated appendicitis was 19.3% (26pts.). The mean time of delay from the onset of the abdominal pain to the operating room was 23 hours and 41 hours in the non perforated and perforated groups respectively with pre admission and post admission delay were 16 and 5.40 hours respectively in the non perforated group in contrast to 35 and 5.54 hours respectively in the perforated group. More than 65% of both groups reached the operating room within 6hours from their admission to hospital. Conclusion: Differences in the length of the pre hospitalization phase of the disease play an important role in increasing the rate of perforation in patients with acute appendicitis in addition to other patient’s related factors particularly age. Variation of few hours in the timing of surgical operation after admission appears to be less contributory factor to perforation and lastly, a second opinion from senior colleague is warranted for diagnosing an equivocal case.