Publication:

An investigation into the frequency of negative appendectomies and contributing factors in patients with suspected acute appendicitis

Background Acute appendicitis is a common cause of acute abdominal pain in young adults, with varying diagnosis accuracy leading to a significant rate of negative appendectomies, particularly in females and younger patients. This study aimed to evaluate the prevalence of negative appendectomy in patients with suspected acute appendicitis.

Methods A cross-sectional study was conducted at Dhaka medical college hospital from January 2022 to June 2024, involving 220 patients diagnosed with suspected acute appendicitis. Clinical history, examination, and relevant pre-operative investigations were performed. All patients underwent surgery, and histopathological examination of the excised appendices was conducted.

Results Acute appendicitis was confirmed in 175 patients (79.55%), with the highest incidence in individuals aged 10-19 years (54.1%). The negative appendectomy rate was 20.45%, with significantly higher rates in females (77.8%) compared to males (22.2%) (p=0.004). Younger patients (age 99.4° F) (60%), and localized tenderness in the right iliac fossa (77.8%). Of the 64 patients who underwent pre-operative ultrasound, 63% experienced negative appendectomy. Histopathological examination revealed that 45 patients (20%) were diagnosed as not having appendicitis, with alternative conditions identified in several cases.

Conclusions The study highlights a significant rate of negative appendectomies, particularly in younger females. While clinical judgment plays a crucial role in diagnosis, the findings suggest a need for enhanced diagnostic imaging techniques to reduce unnecessary surgical interventions.