2001, Number 3
PDF size: 4. Kb.
ABSTRACTObjective: To analyze the factors cansing delay in the surgical treatment of appendicitis. Setting: Third level health care hospital.
Design: Observational, prospective, longitudinal, descriptive study without control group.
Patients and method: We studied 78 patients subjected to surgery with pre or post-operative diagnosis of appendicitis. Variables: evolution since pain initiation, number of hours elapsed before surgery, pre hospital treatment, initial diagnosis out or in the hospital and post-operative diagnosis, therapeutics and complications.
Results: From the 78 patients, 18 (23%) had a definitive diagnosis different from the one made before surgery; 12 (16%) patients had normal appendices and 6 (7.6%) were false negatives. Average time between pain initiation and surgery was of 64.6 hours (2.7 days); 44% was operated after 48 hours fifty (64%) were advanced appendicitis, six (7.6%) coursed with generalized peritonitis, with an average time of 76 hours = 3,29 days. Purulent material was found in 28 (37%), perforation of the appendix in 17 (22% Pres-surgery time for women was 3.2 days, for men it was 2.2 days. Wound infection occurred in 15 (19%). Sixty patients (77%) had seen a physician before admittance to the hospital; in 24 (40%), appendicitis had been diagnosed, in 32 (53%), diagnosis failed.
Drugs prescribed by the physician or self. Medicated had been taken by 98%.
Conclusion: Five out of 10 physicians erred the pre-hospital diagnosis, 98% of patients received medication before reaching the hospital. Errors in diagnosis and automedication were factors that delayed surgery.
Langenscheidt P, Lang C, Puschel W, Feifel G. High rates of appendicectomy in a developing country an attempt to contribute to more rational use of surgical resources. Eur J Surg 1999; 165: 248-52.
Barker DJ, Morris J. Acute appendicitis, bathrooms, and diet in Britain and Ireland. Br Med J (Clin Res Ed ) 1988; 296: 953-5.
Athié Gutiérrez C, Guízar Bermúdez C, Rivera Reyes HH. Epidemiología de la patología abdominal aguda en el servicio de urgencias del Hospital General de México: Análisis de 30 años. Cir Gen 1999; 21: 99-104.
Ricci MA, Trevisani MF, Beck WC. Acute appendicitis. A 5-year review. Am Surg 1991; 57: 301-5.
Andersson RE, Hugander A, Thulin AJG. Diagnostic accuracy and perforation rate in appendicitis: association with age and sex of the patient and with appendicectomy rate. Eur J Surg 1992; 158: 37-41.
Blomquist P, Ljung H, Nyren O, Ekbom A. Appendectomy in Sweden 1989-1993 assessed by the Impatient Registry. J Clin Epidemiol 1998; 51: 859-65.
Korner H, Sondenaa K, Soreide JA, Andersen E, Nysted A, Lende Th et al. Incidence of acute nonperforated appendicitis: age-specific and sex-specific analysis. World J Surg 1997; 21: 313-7.
Zaldivar Ramírez FR, Ramírez Tapia D, Guízar Bermúdez C, Athié Gutiérrez C, Rodea Rosas H, Gómez Gutiérrez N. Perfil de atención de la patología apendicular en el servicio de urgencias: análisis de 1,024 pacientes. Cir Gen 1999; 21: 126-30.
Kraemer M, Kremer K, Leppert R, Yang Q, Ománn C, Fuchs KH. Perforating appendicitis: is it a separate disease? Acute Abdominal Pain Sutdy Group. Eur J Surg 1999; 165: 473-80.
Kokoska ER, Silen ML, Tracy TF Jr, Dillon PA, Cradoct TV, Weber TR. Perforated appendicitis in children: risk factors for the development of complications. Surgery 1998; 124: 619-25; discussion 625-6.
Keller MS, McBride WJ, Vane DW. Management of complicated appendicitis. A rational approach based on clinical course. Arch Surg 1996; 131: 261-4.
Bergeron E, Richer B, Gharib R, Giard A. Appendicitis is a place for clinical judgement. Am J Surg 1999; 177: 460-2.
Walker AR, Segal I. Appendicitis: an African perspective. J R Soc Med 1995; 88: 616-9.
Williams N, Jackson D, Lambert PC, Johnston JM. Incidence of non-specific abdominal pain in children during school term: population survey based on discharge diagnoses. BMJ 1999; 318: 1455.
Vargas Domínguez A, Avilés Lugo JJ, Fernández Hidalgo E, Rivera Reyes HH. Morbimortalidad en 319 casos de apendicitis. Cir Gen 1983; 7: 253-5.
Vargas Domínguez A, Ortega León LH, Miranda Fraga P. Reoperaciones en apendicitis. Rev Gastroenterol Méx 1993; 58: 346-9.
Groth D, Henderson SO. Necrotizing fasciitis due to appendicitis. Am J Emerg Med 1999; 17: 594-6.
Bittinger F, Brochhausen C, Kohler H, Lehr HA, Otto M, Sharke C et al. Differential expression of cell adhesion molecules in inflammed appendix: correlation with clinical stage. J Pathol 1998; 186: 422-8.
Schrenk P, Rieger R, Shamiyeh A, Wayand W. Diagnostic laparoscopy through the right lower abdominal incision following open appendectomy. Surg Endosc 1999; 13: 133-5.
Vargas Domínguez A, Ortega León LH, Miranda Fraga P. Utilidad de la clínica en el diagnóstico de apendicitis. Cir Cirj 1995; 63: 93-6.
Ortega León LH, Vargas Domínguez A, Miranda Fraga P. Complicaciones locales de la apendicitis. Rev Gastroenterol Méx 1994; 59: 223-6.
Vargas Domínguez A, Ortega León LH, Miranda Fraga P. Sensibilidad, especificidad y valores predictivos de la cuenta leucocitaria en apendicitis. Cir Gen 1994; 16: 1-3.
Eriksson S, Styrud J. Interval appendectomy: a retrospective study. Eur J Surg 1998; 164: 771-4.
Vermeulen B, Morabia A, Unger PF, Goehring C, Grangier C, Skljarov I, et al. Acute appendicitis: influence of early pain relief on the accuracy of clinical and US findings in the decision to operate a randomized trial. Radiology 1999; 210: 639-43.
Ohmann C, Yang Q, Franke C. Diagnostic scores for acute appendicitis. Abdominal Pain Study Group. Eur J Surg 1995; 161: 273-81.
Rucinski J, Fabian T, Panagopoulos G, Schein M, Wise L. Gangrenous and perforated appendicitis: a meta-analytic study of 2532 patients indicates that the incision should be closed primarily. Surgery 2000; 127: 136-41.