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KMID : 0376419800040010171
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Chonbuk University Medical Journal
1980 Volume.4 No. 1 p.171 ~ p.186
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A Clinical Study of the Acute Appendicitis
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Abstract
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The collected data of 297 cases of acute appendicitis who were diagnosed by operation at the Dept, of Surgery, Jeonbug National University Hospital during the past 4 years period from April, 1975 to March, 1979 have been analysed on various clinical aspects.
The results were as follow:
1) Among the 297 cases of acute appendicitis, 1:35 cases(45.4%) were complicated appendicitis, and the incidence of periappendiceal abscess. was highest (20.9%) in this complicated type.
2) The male to fenVle ratio was about 1,1 : 1, and the incidence was highest in the 3rd(28.3%)and the 2nd(21, 9%) decades, but the incidence of complicated one according to age groups was highest in the group over the age of 70(80.0%), and followed by the 6th, the 1st, and the 7th decades(over 70%).
3) The seasonal prevalence was highest in the summer(28.3%), but it has no statistical significance.
4) The mean duration of symptoms was 2.2 days in simple appendicitis, and 7.1 days in complicated one.
5) The main symptoms and findings were R. L. Q. pain, tenderness and rebound tenderness, but generalized pain, tenderness and rebound tenderness, fever and chill, diminished peristalsis, R. L. Q. mass, and rigidity were observed more frequently in the complicated appendicitis.
6) Leukocytosis over 10,000 per cubic milliliter was observed in 222 cases (74.7%), but there was no significant difference in the degree of leukocytosis between simple and complicated appendicitis.
7) Widal test was performed in 45 cases who were difficult to differentiate from typhoid fever clinically. 15 cases(33.3%) of them showed false-positive result. X-ray films showed the paralytic ileus in 71.8% and the non-specific finding in 16.1%.
8) The frequently sssociated conditions were pulmonary diseases(6.2%), cardiovascular diseases(2.3%), pregnancy (1.5%), and psychiatric problems.
9) The most frequently used skin incision was Davis-Rockey incision in simple appendicitis, and right pararectal incision in complicated one. Among the complicated cases, only drainage procedure was done in 5.9% and right hemicolectomy in 3.0%.
10) The bacterial culture and sensitivity test of peritoneal fluid were done in 107 cases of complicated appendicitis. E. coli, highly sensitive to Gentamicin, Minocin, and Kanamycin, was the most common microorganism(52.3%).
11) The rate of misdiagnosis was 8.4% (15 cases).
12) The complications developed in 102 cases(34.3%) and in the complicated appendicitis mainly (79.4 % of all complicated cases). They were wound infection (62 cases, 20.9%), adhesive ileus (26 cases, 8.8%), atelectasis (21 cases, 7.1%), intraabdominal abscess (18 cases, 6.1%)and others.
The mortality rate was zero.
13) Compared with other various conventional methods, saline irrigation with pressure and primary closure of the operative wound was the most effective method for the prevention of wound infection in the complicated appendicitis.
14) The mean duration of hospitalization was 6.3 days in the simple appendicitis and 14.1 days in the complicated one.
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