NEGATIVE APPENDECTOMY
| Autor: | Mohammad Ibrar, Bakhtiar Alam, Zafar Iqbal Malik |
|---|---|
| Rok vydání: | 2015 |
| Předmět: | |
| Zdroj: | The Professional Medical Journal. 22:167-174 |
| ISSN: | 2071-7733 1024-8919 |
| DOI: | 10.29309/tpmj/2015.22.02.1370 |
| Popis: | Acute appendicitis is the most common surgical emergency. Despite advancesin diagnostic techniques, an accurate pre-operative diagnosis may still pose a challenge tothe clinicians. Therefore, even today we are facing a high rate of negative appendectomy.The current study explores this aspect of a common and important disease. Objectives: Toknow the percentage of negative operative findings in acute appendicitis in our hospital thatdrains wide area of population from lower socioeconomic strata. Patients and methods: Thisprospective cross-sectional study was conducted at Department of Surgery, Lady ReadingHospital, Peshawar within two years from 1-1-2009 to 31-12-2010. This study included 673cases undergoing appendectomy. All the patients operated for clinical diagnosis of acuteappendicitis over the study period were included. Their history, clinical features, and resultsof investigations were noted. Gross examination of intact appendix specimen, and on-tablecross sectional inspection of appendix was made; and were correlated with histopathologicalfindings (as gold standard). Results: The study included 673 patients. There were 478 males(70%), and highest number of patients was in second decade of life. On gross examination,545 (81%) appendices were swollen, 531 (79%) were reddened due to inflammation; 63 (9.4%)were gangrenous; and 50 (7.5%) had perforated; while in 128 patients (19%) the appendix wasnormal looking with shiny surface. Fibrino-purulent exudate in the peri-appendeceal regionwas noticed in 253 (37.6%) patients. The cut section of appendix showed wall abscess in 474(70.4%) cases, and mucosal ulceration in 325 (48.2%). Necrotic foci in mucosa were seen in188 (27.6%) cases, and in 61 cases (9%) the necrosis was extending through the wall up toserosa. Histopathology revealed marked acute inflammation in 416 (61.8%) cases, moderateinflammation in 92 (13.7%), and mild inflammation in 47 (6.9%); while in 118 cases the appendixhad no evidence of inflammation (giving negative appendectomy rate of 17.5%). Negativeappendectomy rate in females was 29.2% compared to 12.7% in males. Probable alternatediagnoses are also addressed. Conclusions: The negative appendectomy can be avoidedin many cases if ultrasound facilities were available during odd hours of patient presentation.Similarly, the rate of negative appendectomy can be further reduced in adults, especially femalesaround puberty and reproductive age, by the provision of laparoscopy during emergency hoursof the day. |
| Databáze: | OpenAIRE |
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