BMJ 1994;308:107-110 (8 January)

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Indications for operation in suspected appendicitis and incidence of perforation

R Andersson, A Hugander, A Thulin, P O Nystrom, G Olaison 

Department of Surgery, Ryhov Hospital, S-551 85 Jonkoping, Sweden Department of Surgery, University Hospital, Linkoping, Sweden Correspondence to : Dr. Andersson.

Abstract

Objective : To clarify poorly understood epidemiological features of appendicitis.
Design : Retrospective study of consecutive cases from a defined population and analysis of data from published studies.
Setting : County of Jonkoping, Sweden. 3029 patients who underwent operation in 1984-9 and 4717 patients from the county town who underwent operation in 1970-89, all for suspected appendicitis, plus 48 426 cases from six reported studies.
Main outcome measures : Incidences specific for age and sex and temporal trends of perforating and non-perforating appendicitis and removal of a normal appendix. Associations between diagnostic accuracy, rate of perforation, and incidences of removal of a normal appendix and of perforating and non-perforating appendicitis.
Results : The incidence of appendicitis was 116/100 000 inhabitants. Appendicitis was more common in male patients. The incidence of perforating appendicitis was independent of age, stable overtime, and uninfluenced by the rate of laparotomy, whereas the incidence of non-perforating appendicitis was age dependent, decreasing over time, and related to the diagnostic accuracy and rate of removal of a normal appendix.
Conclusions : Perforating and non-perforating appendicitis seem to be separate entities, and appendicitis that resolves spontaneously is common. This may have important implications for managing suspected appendicitis.

Clinical implications

  • Clinical implications

  • The incidence of appendicitis is declining and shows large geographical variations

  • A liberal attitude to exploration with an accompanying high rate of negative results (up to 50% in women) has been accepted in the hope of preventing perforation

  • In this study perforating and non-perforating appendicitis seemed to be different entities, and spontaneously resolving appendicitis was common

  • The readiness to explore influences the detection of resolving appendicitis and may explain variations in incidence of appendicitis and perforation rate

  • Perforation rate is useless as a measure of quality of management in suspected appendicitis


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Rapid Responses:

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laparoscopy or celioscopy
Michael H Childress
bmj.com, 7 Sep 2002 [Full text]
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