Apendicitis Aguda

The THAI Journal of SURGERY 2003; 24:81-84.
Official Publication of the Royal College of Surgeons of Thailand

Acute Appendicitis : A 5-year Review of
Histopathology and Clinical Presentation
Nampet Ngodngamthaweesuk, MD
Anucha Tunthangtham, MD
Dusadee Sakonya, MD
Division of Pathology, Faculty of Medicine, Thammasat University, Patumthani 12121, Thailand.

Abstract

Background:Appendicitis is one of the most common causes of acute abdominal pain. Study of
diagnostic accuracy and pathological correlation aiming to reduce not only late complications but also the rate
of negative appendectomy had been studied worldwide.

Patients and Methods:

The diagnostic accuracy and important clinical presentations of acute appendicitis

in 449 patients who underwent appendectomyin a 5-year period from 1996 to 2001 were retrospectively studied.
The pathological reports were reviewed and grouped into Group I, acute appendicitis with or without
perforation and Group II, no acute inflammation of appendix. Clinical information of age, sex, body
temperature, and laboratory findings were analyzed by Chi-square test and p 0.05

Blood Examination
52 % < Hct < 36 %
WBC count>10,000 cells/cumm
Neutrophill >75 %
(Neutrophils 80-85%)

62
349
329

12
38
31
4

> 0.05
> 0.05
< 0.05**
< 0.05**

208

35

Sex

Urine
Presence of WBC
**P 0.05

Vol. 24

No. 3

Acute Appendicitis : A 5-year Review of Histopathology and Clinical Presentation

DISCUSSION
The diagnosis of acute appendicitis remains mostly
on the basis of clinical manifestation.The problem in
making a clinical diagnosis of appendicitis is that in
addition to appendicitis, there are other possible
surgical and nonsurgical causes of lower abdominal
pain. The signs and symptoms associated with
appendicitis have been found to have sensitivity between
16 and 100 percent and specificity between 36 and 95
percent.11 Therefore, other diagnostic modalities such
as plainabdominal radiographs,12,13 barium enema,14
and ultrasonography15 have been clinically employed
to aid in clinical evaluation, but none has demonstrated
a clear advantage over a careful clinical examination.
In this study, the diagnostic accuracy (88.2%) was
in the same range generally reported in the literatures.3,11-15,19-22 Male patients operated upon for lower
abdominal pain hadhistological feature of acute
appendicitis significantly more than females.
Appendectomies without histological feature of
acute appendicitis were found more in female in most
reports.8-10,18,23-25 However laparoscopy may prove to be
a useful tool when the diagnosis of appendicitis is not
clear, especially in female who may have other causes
of lower abdominal pain such as ovarian cysts, pelvicinflammatory disease, and ectopic pregnancy.16-18
In addition to patient gender, age was the other
important clinical feature in appendicitis. In this
study, young children (75%)
especially in range of 80-85 percent was significant.
Hence, the finding of neutrophilia in patient with
lower abdominal pain is more useful than leukocytosis
alone in the diagnosis of acute appendicitis.

83

Noany single symptom or sign permits definite
diagnosis of acute appendicitis. The use of scoring
systems to enhance accuracy in the diagnosis of
appendicitis, such as Alvarado score,26 is gaining
popularity because it can be used in hospitals lacking
of certain diagnostic facilities. The score points are
derived from the following findings: migratory right
iliac fossa pain, anorexia, nauseaand vomiting, RLQ
rebound tenderness, elevated body temperature,
leukocytosis with or without increased neutrophil.
Is pathological report of normal appendix in
patients with clinical diagnosis suspicious of acute
appendicitis actually normal? There had been report
that approximately 25 per cent of histologically normal
appendices removed from patients with preoperative
diagnosis of...