ACUTE APPENDICITIS: THE DURATION OF THE DISEASE AND OF DYNAMIC OBSERVATION, CLINICAL DIAGNOSIS, PATHOLOGICAL CONCLUSION, DIAGNOSTIC TESTS (IN ONE CLINICAL HOSPITAL)
Abstract
Background. The typical symptoms of acute appendicitis (AA) may be absent in 20–33% of patients. If AA is suspected, dynamic observation, laboratory tests, and ultrasound examination of abdominal organs are performed. Objective – to evaluate the clinical presentation of AA at prehospital and hospital stages, to establish correlation of clinical diagnoses and histopathological findings, as well as the informativeness of laboratory and instrumental diagnostic methods for АA. Material and methods. 233 medical records of patients who underwent an appendectomy were analyzed. Results. The average time from hospital admission to surgery for chronic appendicitis is 8,3 ± 4,3 h, for catarrhal forms of AA – 7 .2 ± 2 h, for phlegmonous forms of AA – 4,5 ± 1h, for gangrenous forms of AA – 3,8 ± 1,2 h. The discrepancy between clinical diagnosis and histopathological conclusion was revealed in 56 cases (24%). In 14 cases, phlegmonous appendicitis, as evidenced by histopathological conclusion, had been considered to be catarrhal during surgery. For phlegmonous and gangrene appendicitis with the cut-off threshold for the white blood cell level of 9,0*109/l the sensitivity of the test reached 84,7%. An ultrasound scan detected gangrenous, phlegmonous and altered vermiform appendix (according to the histopathological conclusion) in 42% of cases. Conclusions. The time before surgery is inversely proportional to the degree of inflammation of the vermiform appendix. The intraoperative visual assessment of the vermiform appendix is not accurate. Routine diagnostic tests (white blood cell count and ultrasound examination) aren’t often useful for the detection of AA.References
1.Saverio SD, Birindelli A, Kelly DK, Catena F, Weber DG, Sartelli M, Sugrue M, Moya MD, Gomes CA, Bhangu A, Agresta F, Moore EE, Soreide K, Griffiths E, Castro SD, Kashuk J, Kluger Y, Leppaniemi A, Ansaloni L, Andersson M, Coccolini F, Coimbra R, Gurusamy KS, Campanile FC, Biffl W, et al. WSES Jerusalem guidelines for diagnosis and treatment of acute appendicitis. World Journal of Surgery. 2016;11:Art. 34. https://doi.org/10.1186/s13017-016-0090-5.
2. The R Project for Statistical Computing [Internet]. Available from: https://www.r-project.org/.
3. Clarkson DB, Fan Y, Joe H. A Remark on Algorithm 643: FEXACT: An Algorithm for Performing Fisher’s Exact Test in R x C Contingency Tables. ACM Transactions on Mathematical Software. 1993;19(4):484-488. https://doi.org/10.1145/168173.168412.
4. Hommel G. A Sagewise rejective multiple test procedure based on a modified Bonferroni test. Biometrika. 1988;75(2):383-386. https://doi.org/10.1093/biomet/75.2.383.
5. May WL, Johnson WD. Properties of simultaneous confidence intervals for multinomial proportions. Communications in Statistics - Simulation and Computation. 1996;26(2):495-518. https://doi.org/10.1080/03610919708813393.
6. Cameron DB, Williams R, Geng Y, Gosain A, Arnold MA, Guner YS, Blakely ML, Downard CD, Goldin AB, Grabowski J, Lal DR, Dasgupta R, Baird R, Gates RL, Shelton J, Jancelewicz T, Rangel SJ, Austin MT. Time to appendectomy for acute appendicitis: A systematic review. Journal of Pediatric Surgery. 2018;53(3):396-405. https://doi.org/10.1016/j.jpedsurg.2017.11.042.
7. Strong S, Blencowe N, Bhangu A. How good are surgeons at identifying appendicitis? Results from a multi-centre cohort study. International Journal of Surgery. 2015;15:107-112. https://doi.org/10.1016/j.ijsu.2015.01.032.
8. Giljaca V, Nadarevic T, Poropat G, Nadarevic VS, Stimac D. Diagnostic accuracy of abdominal ultrasound for diagnosis of acute appendicitis: systematic review and meta-analysis. World Journal of Surgery. 2017;41(3):693-700. https://doi.org/10.1007/s00268-016-3792-7.
