[Perforation rate and diagnostic accuracy in acute appendicitis]

Abstract

Objective: To determine perforation rate and diagnostic accuracy in acute appendicitis.

Design: Retrospective study.

Setting: Deaconesses' hospital Utrecht.

Method: Data on 235 acute appendectomies performed between 1989 and 1991 were collected: duration of symptoms, doctor or patient delay, pathology, septic complications, and objective data such as body temperature, leukocyte count and sedimentation rate.

Results: Symptoms lasted on average 1.68 days and in 12.3% of the cases there was doctor delay, while an accurate diagnosis was made in 80%. The perforation rate was 18.3% and tended to be higher in young children and adults over 50. Septic complications ensued in 25% of the perforations. Perforation was associated with symptoms existing for longer than 48 hours. The number of negative appendectomies was 5 times higher in women than in men. The objective data were of limited diagnostic value. According to literature of the last 15 years, the mean value for perforation rate is 17% and for diagnostic accuracy 79%.

Conclusion: In children and elderly appendicectomy should be considered earlier. For sexually mature women additional laparoscopy can be of help in decreasing the number of negative appendectomies. It is recommended not to observe patients too long.