Analysis of intraoperative findings with clinico-pathological features in appendicitis-an observational study
DOI:
https://doi.org/10.18203/2349-2902.isj20215138Keywords:
Acute appendicitis, Chronic, Recurrent, Recurrence, Histopathological findingsAbstract
Background: Appendectomy is the most common abdominal surgery performed today. Appendicitis consists of vast spectrum ranging from acute to chronic to recurrent forms however existence of recurrent and chronic appendicitis is still doubted by many. In spite of various scoring systems and appendectomy being the ultimate treatment, its timing remains still controversial especially in chronic and recurrent variants of appendicitis.
Methods: A total of 100 consecutive cases of suspected appendicitis who were admitted investigated and treated at our centre were taken up for this observational study. Data pertaining to clinical, operative and histopathological findings were collected and tabulated. Mean and SD were used for continuous data and for categorical data, frequency and percentages were calculated. A chi-square test was used for categorical data to find statistical significance.
Results: Per operatively the appendix appeared non-inflamed in 57% of patients suggestive of chronic (recurrent) form and inflamed in 43% of patients suggestive of an acute form of appendicitis. The histopathological studies revealed chronic inflammatory cells in 63% of the resected specimens, suggestive of chronic appendicitis and acute inflammatory cells in 37% of the specimens, suggestive of acute appendicitis.
Conclusions: We conclude that the correlation of clinical findings, operative findings and the histopathological findings correlate with one another (p<0.001). The surgeon’s clinical and operative findings have specificity of around 87.30% and 90.47% respectively. Hence the diagnostic accuracy of the surgeon is directly dependent on the surgeons’ expertise and there is no substitution for an experienced surgeon’s judgement.
References
Ooms HW, Koumans RK, Ho Kang You PJ, Puylaert JB. Ultrasonography in the diagnosis of acute appendicitis. Br J Surg. 1991;78(3):315-8.
Smink DS, Soybel DI. Appendix and Appendectomy. In: Zinner, MJ, Ashely SW (eds.) Maingot’s abdominal operations. 11th edition. New York: McGraw Hill; 2007: 589-612.
O' Connel PR. The Vermiform Appendix. In: Russell RCG, Willaims NS, Bulstrode CJK (eds.) Bailey and Love's short practice of surgery. 24th edition. London: Hodder Arnold: 2012;1210-11.
Barber MD, McLaren J, Rainey JB. Recurrent appendicitis. Br J Surg. 1997;84(1):110-2.
Chichom Mefire A, Tchounzou R, Kuwong PM, Atangana JP, Lysinge AC, Malonga EE. Clinical, Ultrasonographic, and Pathologic Characteristics of Patients with Chronic Right-lower-quadrant Abdominal Pain that May Benefit from Appendectomy. World J Sur. 2011;35(4):723-30.
Safaie M, Rasti M, Moeini l. Recurrent abdominal pain and chronic appendicitis. J Res Med Sci. 2004;9(1):11-4.
Limchareon S, Dinchuthai S. Non-acute appendicitis: Clinico-radiopathologic findings and management. Vajira Med J. 2014;58(1):21-4.
Rao P, Rhea J, Novelline R, McCabe C. The computed tomography appearance of recurrent and chronic appendicitis. Am J Emergency Med. 1998;16(1):26-33.
Berk D, Sylvester K. Subacute Appendicitis. Clin Pediatr. 2005;44(4):363-5.
Kim D, Butterworth SA, Ran D. Goldman Chronic appendicitis in children. Canadian Family Physician. 2016;62(6):e304-5.
Jones MW, Paterson AG. The correlation between gross appearance of the appendix at appendicectomy and histological examination. Ann R Coll Surg Engl. 1988;70(2):93-4.
Grunewald B, Keating J. Should the “normal” appendix be removed at operation for appendicitis? J R Coll Surg Edinb 1993;38(3):158-60.
Andiran F, Dayi S, Caydere M, Ustun H. Chronic Recurrent Appendicitis in children: An Insidious and Neglected Cause of Surgical Abdomen. Turk J Med Sci. 2002;32:351-4.
Nahar K, Hossain S, Khatun A. Chronic Appendicitis: Diagnostic Dilemma in Female Patient for Recurrent Lower Abdominal Pain. J Shaheed Suhrawardy Med College. 2018;10(1):59-65.
Rautio M, Sax NH, Siitonen A, Nikku R, Jousimies Somer H. Bacteriology of histopathologically defined appendicitis in children. Pediatr Infect Dis J. 2000;19(11):1078-83.
Sarosi GA, Turnage RH. Appendicitis. In: Feldman M, Friedman LS, Sleisenger MH, edts. Sleisenger and Fordtran’s GI and Liver disease, pathophysiology, diagnosis and management. 7th edition. Pennsylvania. Saunders Elsevier. 2089-97.
Jade RS, Muddebihal UM, Naveen N. Modified Alvarado score and its application in the diagnosis of acute appendicitis. Int J Contemporary Med Res. 2016;3(5):1398-400.
Mahesh MS, Naveen N, Kolliyavar SS. A Study of Pre-Operative Diagnosis of Acute Appendicitis Using Alvarado Score in Rural Population. J Evolution Med Dental Sci. 2015;4(38):6590-601.
