Hospital Admission Rate of Perforated Appendix

Original Article


Mohamed Algabsi, Abo Baker Swissi, Hamad Rafe

Department of Surgery, Al-Wahda Hospital, Faculty of Medicine Omar Al Mokhtar University, Derna, Libya

JMJ 2009,Vol.9, No.1: 31-35


Background: Acute appendicitis is a common emergency in children. The current trend is to perform appendicectomy once acute appendicitis is diagnosed. Objectives: To evaluate the types of appendices removed for acute appendicitis and correlate them with clinical features, and to assess the number of admissions for perforated appendix per 100 admissions for appendicitis within Al-Wahda Hospital, Derna, Libya, during 2006. Patients and Methods: A respective study include 480 patients of acute appendicitis who had undergone appendicectomy. The parameters evaluated were age, gender, clinical presentation, total leucocytes counts and urine examination. The operative findings were recorded and the inflammation of the appendix was graded into uncomplicated, complicated and normal. Results: A total of 480 patients, 190 (39.6%) males and 290 (60.4%) females were studied who were operated upon for acute appendicitis after a clinical diagnosis. The male to female ratio was 1:1.5. The mean age was 20.2 years. The main features at presentation were right lower quadrant abdominal pain (100%), tenderness (100%), vomiting (96.7%), nausea (50.4%), rigidity (45.8%), and anorexia (17.5%). The mean total leucocytes count was (12400 /mm³ ). It was less than 10,000/mm³ in 160 (33.3%) patients (all of them cured), and more than 10,000 /mm³ and less than 20,000 /mm³ in 290 (61.2%) cases and 30 (6.3%) patients with TLC more than 20,000 /mm³. The sensitivity and specificity of raised white cell count in acute appendicitis were 72.7% and 68.6%, respectively. Surgical findings included acute inflamed appendicitis in 250 (52.1%) patients and perforated appendicitis in 160 (33.3%) patients. Conclusion: Clinical assessment is the best criterion to reach a confident diagnosis of appendicitis. Total leukocyte count and other investigations should be used as diagnostic aid in doubtful cases but they do not replace the clinical skills of general surgeons.

Keywords: Acute appendicitis, Diagnosis, Perforation.