Risk factors for perforation in acute appendicitis

Abstract

This prospective study was carried out on 720 patients with acute appendicitis admitted to the surgical unit at Al-Diwaniya Teaching Hospital over a period of 3 years from January 2010 to December 2012. The data of the patients regarding clinical history,physical examination, investigations,operative findings and histopathology reports were analyzed .Acute appendicitis was more common in the second decade of life (44.4%) and was more common in males(55.97%) than in females (44.02%) .Perforated appendicitis was found in 144 pateints (20%).The incidence of perforated appendicitis was high in males (56.25%) as compared to females (43.75%). The risk factors for perforation in acute appendicitis include:extremes of age (< 10 years and > 60 years) ,delayed presentation (> 72 hours), diabetes mellitus ,steroid dependency , elevated temperature (>38ËšC) ,raised WBC count (>18.000\ mm3), pelvic appendix ,obstructive appendicitis (fecolith) , and pregnancy (the P-value was <0.05). The morbidity and mean hospital stay were more in perforated appendicitis than in non perforated appendicitis .The mortality rate in perforated appendicitis was (2.08%) , while there was no death recorded in non-perforated appendicitis. We should be aggressive in the treatment of appendicitis in high risk patients, so once acute appendicitis is diagnosed , the expedient surgery and appropriate use of perioperative antibiotics can help to minimize the morbidity and mortality.