Acute appendicitis - a benign disease?

Authors: Simpson, J.; Samaraweera, A.P.R.; Sara, R.K.; Lobo, D.N.

Source: Annals of The Royal College of Surgeons of England, Volume 90, Number 4, May 2008 , pp. 313-316(4)

Publisher: The Royal College of Surgeons of England

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Abstract:

INTRODUCTION: Appendicitis is the most common cause of the acute abdomen and can affect all age groups. Most patients recover quickly but a minority can suffer postoperative complications. This case-note review was undertaken to assess the frequency of these complications.

PATIENTS AND METHODS: Adult patients (> 16 years) undergoing an emergency appendicectomy at a University teaching hospital between February 2004 and January 2005 were identified from pathology records. Details of operative procedure, histology and postoperative complications were noted from the hospital case notes

RESULTS: A total of 199 patients with a median age of 31 years (range, 16-89 years) were identified. Of these, 58 (29%) patients experienced a postoperative complication. Eight (4%) patients were admitted to the surgical high dependency unit or intensive care unit postoperatively and there was one death (0.5%). Re-operation for a postoperative complication was required in 9 (4.5%) patients and there was a 13% re-admission rate (26 patients). Comparison between patients with histologically proven appendicitis (164 patients; 82%) and those patients having a negative appendicectomy (35 patients; 18%) showed no significant difference in the rate of complications as defined (43 of 164, 26% versus 15 of 35, 43%; P = 0.08). However, patients with positive histology were more likely to experience a septic complication (29 of 164, 18% versus 1 of 35, 3%; P = 0.028) and all re-operations came from this group. Despite this, patients with a negative appendicectomy were more likely to be re-admitted (12 of 35, 34% versus 14 of 164, 8.5%; P = 0.0002), predominantly with persistent abdominal pain.

CONCLUSIONS: Appendicectomy is associated with a significant morbidity. Patients with an inflamed appendix were more likely to experience a septic complication but re-admission was more common in patients with a histologically normal appendix because of unresolved abdominal pain.

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Keywords: ACUTE APPENDICITIS; APPENDICECTOMY; COMPLICATIONS; OUTCOME

Document Type: Research article

DOI: http://dx.doi.org/10.1308/003588408X285973

Affiliations: 1: Division of Gastrointestinal Surgery, Wolfson Digestive Disease Centre, Nottingham University Hospitals, Queen's Medical Centre, Nottingham, UK

Publication date: 2008-05-01

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The Annals of The Royal College of Surgeons of England is the official journal of the College and is published eight times a year in January, March, April, May, July, September, October and November. The main aim of the journal is to publish high quality, peer-reviewed papers that relate to all branches of surgery.

The Annals also includes letters and comments, a regular technical section, NICE news, controversial topics, CORESS feedback, book reviews and the best trainee presentations from England and Wales. The editorial board is composed of members of the College Council and experts from across the surgical specialties.

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Acute appendicitis - a benign disease?

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