Publication:

Clinico-pathological study of appendicitis in a tertiary centre in Vindhya region, Madhya Pradesh, India

Background Appendicitis is one of the commonest conditions responsible for the admission of patients to hospital for surgical treatment. Aim of study was to find the incidence of appendicular lesions according to age and sex and to analyze clinical condition of appendicitis according to Alvarado score and to investigate and correlate the finding with clinical symptoms in relation to TLC, X-Ray abdomen and Ultrasound and to manage the cases accordingly conservatively or subjected to emergency or elective appendectomy. Prospective cohort study.

Methods The Patients with classical symptoms and sign of acute, recurrent and chronic appendicitis were admitted in surgical ward were subjected to investigations including haemoglobin, TLC & DLC, Blood Sugar, Blood Grouping, X-ray chest, x-ray abdomen and ultrasound of abdomen. Patients were evaluated according to Alvarado score. Study was done in 385 patients over 1 year period.

Results Three hundred eighty five patients with Appendicitis were evaluated and incidence of appendicular lesions was 4.28%. Maximum incidence of appendicitis was in age group 21-30 years (33.50%), (30.39%) patients were of Alvarado score 6 or more. Majority of cases 315 (81.82%) out of 385 treat conservatively and 70 (18.18%) patients were operated. Patients with Alvarado score >7, 13 (3.37%) had positive operative findings and 11 (2.85%) had positive histopathological examination and patients with TLC > 10000, 11 (2.85%) had positive operative findings and 11 (2.85%) had positive histopathological examination and polymorph >75,28 (7.27%) had positive operative findings and 28(7.27%) had positive histopathological examination.

Conclusions In this study we found that clinical score is a simple, rapid and non-invasive method to early diagnosis of appendicitis. TLC are inflammatory marker are also useful in early diagnosis of acute appendicitis. Ultrasound abdomen is also useful to confirm the diagnosis. The majority of our patients presented early disease. Conservative approach of treatment gave positive response and then we planned for elective appendectomy after regular interval. Because of these negative appendectomy rate are decreasing and morbidity period are also decreasing pre or post appendectomy. There was much less post-operative complication, which were higher in emergency appendectomy. In our study we concluded that timely intervention reduce the negative appendectomy and reduce the length of morbidity.