CAUSES OF DELAYED PRESENTATION OF ACUTE APPENDICITIS AND ITS IMPACT ON MORBIDITY AND MORTALITY
AbstractBackground: Acute appendicitis is one of the commonest abdominal emergencies and appendectomy is one of the commonest emergency procedures performed all over the world. The study was done with an objective to evaluate the different causative factors for delayed presentation of appendicitis. Methods: This cross-sectional study was carried out in the Surgical “C” unit, at Ayub Teaching Hospital, Abbottabad, Pakistan from 20th June 2013 to 19th June 2014. A total of 130 patients presented with appendicitis in OPDs or emergency department. Detailed history, general physical and systemic examination especially abdominal examination was done along with investigations. Results: It was found that 23.08% of complicated appendicitis presentation is due to missed diagnosis by physicians, 30.77% is due to missed diagnosis by non-doctors, 23.08% is due to conservative management at DHQ hospitals by surgeons, and 23.08% presented late because of self-medication at home. Conclusion: All patients with pain Right iliac fossa, there should be suspected of appendicitis. Proper workup should be done to exclude it. If kept on conservative management then regular monitoring of vitals with laboratory investigations should be done.
Tan V, Stévignon T, Chaddad M, Dugué L. Appendicitis after right colectomy? How can this be possible. J Visc Surg 2014;151(6):477–8.
Muqim RU, Alam Jan QA , Khan MI, Khan S. Diagnostic laparoscopy in the management of Post appendectomy pain right iliac fossa. Isra Med J 2013;5:18–22.
Adamu A, Maigatari M, Lawal K, Iliyasu M. Waiting time for emergency abdominal surgery in Zaria, Nigeria Afr Health Sci 2010;10(1):46–53.
Mohamed A, Bhat N. Acute Appendicitis Dilemma of Diagnosis and Management,” Internet J Surg 2010;23(2):1528–8242.
Von Titte SN, McCabe CJ, Ottinger LW. Delayed appendectomy for appendicitis: causes and consequences. Am J Emerg Med 1996;14(7):620–2.
England RJ, Crabbe DC. Delayed diagnosis of appendicitis in children treated with antibiotics, Pediatr Surg Int 2006;22(6):541–5.
Drake FT, Flum DR. Improvement in the diagnosis of appendicitis. Adv Surg 2013;47:299–328.
Humes DJ, Simpson J. Acute appendicitis. BMJ 2006;333(7567):530–4.
Salati S, Rather A, Wani S. Perforated appendicitis - an experience in a tertiary care center in Kashmir. Internet J Surg 2008;21:1.
Khalil J, Muqim RU. Impact of delay in acute appendicitis. Pak J Surg 2010;26(1):31–5.
Jalil A, Shah SA, Saaiq M, Zubair M, Riaz U, Habib Y. Alvarado scoring system in prediction of acute appendicitis. J Coll Physicians Surg Pak 2011;21(12):753–55.
Chung CH, Ng CP, Lai KK. Delays by patients, emergency physicians, and surgeons in the management of acute appendicitis: retrospective study. Hong Kong Med J 2000;6(3):254–9.
Fahim F, Shirjeel S. A comparison between presentation time and delay in surgery in simple and advanced appendicitis. J Ayub Med Coll Abbottabad 2005;17(2):37–9.
Varadhan KK, Humes DJ, Neal KR, Lobo DN. Antibiotic therapy versus appendectomy for acute appendicitis: a meta-analysis. World J Surg. 2010;34(2):199–209.
Hansson J, Körner U, Ludwigs K, Johnsson E, Jönsson C, Lundholm Kl. Antibiotics as first-line therapy for acute appendicitis: evidence for a change in clinical practice. World J Surg 2012;36(9):2028–36.
Liu K, Fogg L. Use of antibiotics alone for treatment of uncomplicated acute appendicitis: a systematic review and meta-analysis. Surgery 2011;150(4):673–83.
Wilms IM, de Hoog DE, de Visser DC, Janzing HM. Appendectomy versus antibiotic treatment for acute appendicitis. Cochrane Database Syst Rev 2011;9(11):CD008359.
Varadhan KK, Neal KR, Lobo DN. Safety and efficacy of antibiotics compared with appendicectomy for treatment of uncomplicated acute appendicitis: meta-analysis of randomized controlled trials: BMJ 2012;344:e2156.
Turhan AN, Kapan S, Kütükçü E, Yiğitbaş H, Hatipoğlu S, Aygün E. Comparison of operative and non-operative management of acute appendicitis. Ulus Travma Acil Cerrahi Derg 2009;15(5):459–62.
Sauerland S, Jaschinski T, Neugebauer EA. Laparoscopic versus open surgery for suspected appendicitis. Cochrane Database Syst Rev 2010;6(10):CD001546.
St Peter SD, Aguayo P, Fraser JD, Keckler SJ, Sharp SW, Leys CM, et al. Initial laparoscopic appendectomy versus initial non-operative management and interval appendectomy for perforated appendicitis with abscess: a prospective, randomized trial. J Pediatr Surg 2010;45(1):236–40.