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KMID : 0371319950490020268
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Journal of the Korean Surgical Society
1995 Volume.49 No. 2 p.268 ~ p.276
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Diagnostic Accuracy and Complications of Acute Appendicitis and Incidence and Complications of Negative Explorations in 3,303 Cases of Suspected Appendicitis
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Abstract
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Acute appendicitis is still the most common surgical disease of the acute abdomen. The diagnosis may be wrongly made of initially overlooked. The first error leads to an unnecessary opertion and the second to delay. A retrospective study of 3,303
consecutive patients surgically treated for a clinical diagnosis of acute appendicitis was performed at the Taegu Fatima Hospital, Korea.
Of 3,303 appendectomies, appendicitis was found in 83.9%, the normal appendectomies, that is, negative appendectomies were carried out in 13.6% of the patients, and 2.5% showed other appendiceal pathology. Males showed higher diagnostic accuracy
of
87.8% compared wit 79.9% of the females. Of 81 patients with other appendiceal pathology, lymphoid hyperplasia, mucocele, and periappendicitis were the most common entities in order. Of 450 patients who underwent negative appendectomiec, 72 had
other
intraabdominal diseases detected at operation, of which 30 required surgery for the lesion, therefore unnecessary operation, that is, negative exploration was performed in 420 patients or 12.7% of the patients. The most common other
intraabdominal
diseases required and did not require surgery were ovarian cyst or tumor and mesenteric lymphadenitis, respectively., Negative appendectomies were carried out significantly(p<0.001) more common in female than male patients and a significant
number
of
these female patients, especially in the reproductive ages, had gynecologic diseases.
The total of patients with postoperative complications was 440(13.3%) and the most common complication was wound infection which occurred in 7.7% of the patients. Patients with perforated appendicitis showed the highest postoperative complication
rate,
representing 32.1% of the patients. The patients who underwent negative appendectomies and negative explorations also had significant complication rates of 6.7% and 4.8%, respectively. There were no death in this study.
Although many consider the diagnosis of acute appendicitis to be simple and an unevenful appendectomy to be routine, this study shows that in part, acute appendicitis is a difficult disease to diagnose, and not infrequently appendectomy is
performed
only to find a normal appendix, and appendectomy results in significant morbidity even after negative appendectomy. For these reasons, it is desirable to reduce the rate of negative laparotomy without increasing the perforation rate in suspected
appendicitis. This probably can be achieved with a combination of various means of increasing diagnostic certainty preoperatively.
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