Acute appendicitis

In al-Bassel Hospital-Manbej
Dr.Kamiran Hussein
2010 General surgeon

Introduction:
Acute appendicitis is the most common cause of Acute surgical abdomen. The incidence in the male1,33 per1000,female0,99 per 1000,but Recently the rate decreased to 0,5 per1000.A decline in the rate may reflect a change in operative policy or may reflect an improvement in diagnostic ability of the surgical team. The incidence of appendicitis occurs more frequently in Western countries and Australia, and less in Asia, it is undoubtedly much more common among Meat-eating white races, and many surgeons believe that there is a familial tendency in this disease. Appendicitis is approximately 1%of all surgical procedures.

Objective:
The objective of this study is to display: The incidence rate of Appendicitis in the northern part of our country. Relation to Sex. The mean age of cases. Complication rate. Seasonal incidence rate . Comparison with other study.

Methods:
This study has been performed in the public al-Bassel Hospital , department of surgery ,by counting the cases of acute abdomen, which presented to the department for a year,from1/1/2009 until1/1/2010,All the cases of cholecystitis and gallbladder's stones have been excluded. So there were(390)cases, these cases divided according to the location of pain to: Right iliac pain(appendicitis in doubt). Extra iliac pain. In order to know the rate of Appendicitis according to Abdominal pain in general, and to right iliac pain as well. Besides to that the cases have been divided according to Age,Sex

Methods:
(Male-Female-Children under 12 yrs). Then the perforated Appendices,Appendiceal masses, and negative cases after operation also have been collected. The correlation between Laboratories(W.B.C <10000cells as indicator to inflammation) and Appendicitis perforation. Eventually Seasonal role has been revealed.

Results:
390 patients presented to the surgery department over a year (1/1/2009-1/1/2010)with complaint of abdominal pain(123)Male(185)Female-(82) child The complaint concentrated in iliac region in(238)patient(61%) (86 Male-104Female-48Child)(36%-44%-20%)respectively. Whereas the pain in extra iliac region in(152) patient(39%). From(238)patient presented with right iliac pain(159) diagnosed Appendicitis(66,8%)(57Male-58Female-44 child)children(25 Male-19 Female),so total cases according to sex were(82Male-77Female) (52%-48%)respectively. The children comprised(27,6%)(1/3).

Cases 390

Male 123 32%

Female 185 47%

Children 82 21%

Abdominal pain (390)

Right iliac pain (238) (61%)

Extra right iliac pain (152) (38,9%)

Another etiology (78) (33%)

Appendicitis (159) (67%)

Results:
Most of cases (80)(50,3%)were between9-20 yrs,(57)(35,8%) Between20-40yrs,(15)(9,4%)>9yrs,(7)(4,4%)between40-60yrs <60yrs(0)

50,3% 35,8% 4,4% 0% >60 yrs 40-60 yrs 20-40 yrs 9-20 yrs <9 yrs

50%
40% 30% 20% 9,4% 10% 0%

Results:
The number of perforation was(18)(11,32%)(10Male-8Female), Appendiceal mass numbers(6)(3,7%). One negative case has been mentioned(I think there was not credibility in the Operative reports). There was not Tumors, nor Mortalities in these reports. The W.B.C count sensitivity was(70%). There were two peaks of Seasonal incidence rate(March-April) (July-August).

20 15 10 Season Cases 0 Season 9 8 7 6 5 4 3 2 1 5

13

12

11

10

Incidence rate according to season

Discussion:
Reviewing over instances of abdominal pain we notice a predominance of Females (47,4% versus31,5%) Females complaint from right iliac pain more than Males(43,7% versus36,1%). Appendicitis comprises(66,8%) of right iliac complaints, and(40,7%) Of acute abdominal pain. Children comprise(27,6%) of Appendicitis instances(1/3). There is a mild predominance for Males versus Females in Appendicitis(52% versus48%)(1,1/1).In other studies(1,2-1,3/1). The mean age of Patients was20yrs,in comparison to several studies, it was(22 yrs).

Discussion:
(50,3%) of Patients were in the second decade, and(35,8%) in the thirds. The rate of perforation was(11,32%),it is less than other reports (19,1%-25,8%),the peak of perforation at age(19 yrs),whereas according to Schwartz 2007 ,the peak(>5yrs and < 60 yrs),this variance may resulted from the delay in diagnosis. The perforation more frequent in Males than Females. There was not a difference in WBC count between perforated and imperforated appendices. Most instances were in Spring and Summer, many reports in Literature resemble this outcome.

Discussion:
Hospital Ferrara,Italy2006 University of Massachuset. medical center1991LuckmannR,DavisP. South medical journal1987,Aug International Journal of Surgery2007,April There was one negative case (0,6%) ,whereas in Literature it reaches(20%)( it may be as a result of unreliability in surgical report. There was not mortalities . There was not tumors.

Summary:
Appendicitis is considered the most cause of acute abdomen, and it more prevalent in adults, with a predominance of Males, and there was two peaks of incidence (summer and spring). Although the perforation rate in this report was less than another ,and more prevalent in adults, but this needs an extensive study.

References:
Principles of Surgery(Schwartz1999). Principles Of Surgery(Schwartz2007). Manual Of Surgery1997. Principles and Practice Of Surgery1995. Research from Hospital Ferrara,Italy 2006. LuckmannR,Davidp,University of Massachuset Medical Center 1991. South Medical Journal1987 Aug,80(8). International Journal Of Surgery, April 2007.

Thanks