54f7Acute Appendicitis

8/3/2019 54f7Acute Appendicitis

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Acute appendicitis

In al-Bassel Hospital-Manbej

Dr.Kamiran Hussein

General surgeon2010


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Introduction:

Acute appendicitis is the most common cause of Acute surgicalabdomen.

The incidence in the male1,33 per1000,female0,99 per 1000,butRecently the rate decreased to 0,5 per1000.A decline in the rate

may reflect a change in operative policy or may reflect animprovement in diagnostic ability of the surgical team.

The incidence of appendicitis occurs more frequently in Westerncountries and Australia, and less in Asia, it is undoubtedly muchmore common among Meat-eating white races, and many surgeonsbelieve that there is a familial tendency in this disease.

Appendicitis is approximately 1%of all surgical procedures.


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Objective:

The objective of this study is to display:

The incidence rate of Appendicitis in the northern part of ourcountry.

Relation to Sex.

The mean age of cases. Complication rate.

Seasonal incidence rate .

Comparison with other study.


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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,from1/1/2009until1/1/2010,All the cases of cholecystitis and gallbladder's stoneshave been excluded. So there were(390)cases, these cases dividedaccording 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


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Methods:

(Male-Female-Children under 12 yrs).

Then the perforated Appendices,Appendiceal masses, andnegative cases after operation also have been collected.

The correlation between Laboratories(W.B.C


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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) diagnosedAppendicitis(66,8%)(57Male-58Female-44 child)children(25 Male-19Female),so total cases according to sex were(82Male-77Female)

(52%-48%)respectively. The children comprised(27,6%)(1/3).


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ChildrenFemaleMaleCases

82185123390

21%47%32%

Abdominal pain

(390)

Right iliac pain

(238)

(61%)

Another etiology

(78)

(33%)

Appendicitis

(159)

(67%)

Extra right iliac pain

(152)

(38,9%)


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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


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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 notcredibility 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).


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Incidence rate according to season

Season

0

5

10

15

20

12345678910111213

Season

Cases


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Discussion:

Reviewing over instances of abdominal pain we notice apredominance 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 inAppendicitis(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).


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Discussion:

(50,3%) of Patients were in the second decade, and(35,8%) in thethirds.

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),thisvariance 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 inLiterature resemble this outcome.


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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 itreaches(20%)( it may be as a result of unreliability in surgical report.

There was not mortalities .

There was not tumors.


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Summary:

Appendicitis is considered the most cause of acute abdomen, and it

more prevalent in adults, with a predominance of Males, and therewas 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.


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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.


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54f7Acute Appendicitis

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