Publication:

Surgical outcome in patients with complicated appendicitis treated at a medical college hospital

Background Acute appendicitis is the most common surgical emergency requiring operative intervention. Most of the cases are simple; however complicated appendicitis with perforation, abscess and gangrene of appendix is seen in up to 1/4th of adults and 1/3rd of cases in children. It is associated with post operative complications with considerable morbidity. The aim is to study the clinical presentation of complicated appendicitis, the intra-operative findings, post-operative complications and the overall surgical outcome.

Methods It is a cross sectional study of 35 patients who had complicated appendicitis and who were treated with surgery.

Results 83% of patients with complicated appendicitis were younger than 40 years of age, with children constituting about 43% of total cases. All the patients had typical right iliac fossa pain, with tenderness and localized guarding in 37%. Ultrasound diagnosed appendicitis in 80% of cases. Leukocytosis was seen in 71% with neutrophil shift in 85% of patients. 60% of patients had perforation and abscess formation, gangrene in 45% and mass in 37%. Post operative complications were noted in 51% of the patients, commonly paralytic ileus (46%) and wound infection (20%). There was no mortality in our study and the general overall outcome of treatment was good.

Conclusions Complicated appendicitis with gangrene, perforation and abscess form a considerable proportion of cases. Early surgical intervention is the definitive treatment after initial resuscitation. Overall morbidity is considerable, but mortality is less than 1% and the general overall outcome is good with early surgical intervention.