Clinical Features of Complicated Acute Appendicitis
Somrit Mahattanobon MD*,
Srila Samphao MD*, Prakit Pruekprasert MD*
Affiliation :
* Division of General Surgery, Department of Surgery, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
Objective : To identify the clinical features associated with complicated (gangrenous or perforation) acute appendicitis in
the patients who underwent appendectomy.
Material and Method: A consecutive series of adult patients with acute appendicitis who underwent appendectomy at
Songklanagarind Hospital between 2005 and 2010 were retrospectively analyzed.
Results : Nine hundred twenty four patients were evaluated. Median (interquartile range) age was 34.9 (22.4, 50.1) years.
There were 669 (72.4%) simple acute appendicitis and 255 (27.6%) complicated acute appendicitis. Multivariate analyses
showed that age >60 years (OR 1.93, 95% CI 1.23-3.02), duration of symptoms >12 hours (OR 3.29, 95% CI 2.25-4.8),
anorexia (OR 1.69, 95% CI 1.2-2.37), body temperature >38°C (OR 2.38, 95% CI 1.59-3.58), generalized tenderness
(OR 5.36, 95% CI 2.4-11.95), guarding (OR 1.5 95% CI 1.08-2.08), bandemia (OR 1.65, 95% CI 1.16-2.34), pyuria
(OR 1.66, 95% CI 1.07-2.57), urine specific gravity ≥1.020 (OR 1.66, 95% CI 1.18-2.33), and duration from visit to surgery
>12 hours (OR 1.82, 95% CI 1.18-2.82) were related to complicated acute appendicitis.
Conclusion : Ten clinical features can be used to predict the risk of complicated acute appendicitis. However, the strong
factors are duration of symptoms, body temperature, and generalized tenderness. They should be the useful tools for acute
appendicitis management, especially in limited resources situation.
Keywords : Clinical features, Complicated appendicitis, Acute appendicitis, Ruptured appendicitis, Gangrenous appendicitis
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