Effect of Time in the Development of Perforated Appendicitis

Abstract

Background : The aim of this study was to elucidate the natural history of appendicitis with respect to prehospital duration of pain before operation. Methods : We retrospectively evaluated 363 patients who were operated with a pre-diagnosis of acute appendicitis at our hospital. The patients were divided into three groups as acute, phlegmonous, and perforated according to histological and clinical findings. Preoperative white blood cell counts (WBC) and ultrasound reports, age, gender, time before attendence and postoperative hospital stay were recorded. Results : The mean time of pain duration before operation for perforated appendicitis was not significantly longer for patients > 50 years of age compared to younger age groups with perforation. Postoperative complications found higher in group 3. Analysis stratified by age and gender, the total duration of pain before operation was not statistically significant. WBC count and postoperative stay in hospital of Group 3 was significantly higher. Concordance between ultrasound and pathology was not statistically significant. Conclusion : Patient delay in presentation is the predominant factor determining the incidence of complicated appendicitis, and this delay is not influenced by age or gender. Negative appendectomy rates were higher in females who were in reproductive ages. Ultrasound did not improve the diagnostic accuracy when compared to the clinical assessment. doi:10.4021/jcs18e