Comparative Analysis of Clinical Patterns, Laboratory and Radiological Parameters, Intraoperative Findings and Postoperative Course in Patients with Perforated Versus Non Perforated Acute Appendicitis

Background: Appendicitis is one of the most common abdominal emergencies encountered in surgical patients and admissions due to acute appendicitis forms a major portion of hospital admissions in developed as well as developing countries. It is most commonly seen in young adolescent patients but no age is immune to this condition. Males are more commonly affected than females. Acute appendicitis is usually diagnosed clinically in patients presenting with typical history and clinical examination findings. The patients with lesser duration of symptoms usually have non perforated appendix while those having a longer duration of symptoms with signs of peritonitis are more likely to have perforated appendix. Appendicectomy is the treatment of choice. This study is conducted to study acute appendicitis with an emphasis on analyzing the difference in perforated and non perforated appendicitis in context with their presentation, intra-operative features, postoperative outcome and treatment options available for these cases. Aims and Objectives: (1)To study the clinical pattern of presentation and to analyze the difference in the anatomical , biochemical, microbiological and histological determinants in patients of perforated and non perforated acute appendicitis . (2) To evaluate the intraoperative features and postoperative outcome in patients with acute appendicitis presenting with or without perforation. (3) To evaluate the relative importance of these determinants, effect of preoperative delay, pre-hospital antibiotic therapy with postoperative morbidity of perforated acute appendicitis. Methods: This was a clinical prospective study comprising of 150 Patients presenting to a tertiary care centre with intra-operative findings of appendicitis conducted in the department of general surgery, in a postgraduate teaching institute and tertiary medical centre, in Mumbai over a period of 2 years. Results: The analysis of age distribution of the studied cases revealed that most of the patients were in their 2nd or 3rd decades of life. Maximum patients belonged to age group of 20-29 years (22.67%) and 30-39 years (18.67%). There was a male preponderance with the M:F ratio being 1: 0.57. Majority of the patients (64%) has symptoms less than that of 5 days duration. In patients presenting with perforated appendix 34/75 (45.33%) had duration of symptoms between 3-5 days and 20/75 (26.67%) had duration of symptoms between 6-7 days. The duration of symptoms less than 2 days was less commonly associated with perforation and was seen in 21.95% patients. Patients having perforated appendix most commonly presented with symptoms of abdominal pain (100 %), signs of localised peritonitis (85.33%), fever (49.33%), generalised peritonitis (48%) and vomiting (41.33%). In cases of Non-perforated appendix the patients most commonly presented with abdominal pain (100%), localised peritonitis (68%), fever (53.33%), vomiting (52%) and signs of generalized peritonitis (14.66%). Conclusion: Acute appendicites is a common surgical condition. The spectrum of this disease comprises of acute non perforated appendicitis to perforated appenidicitis with peritonitis in neglected cases. Detailed history, careful clinical examination and imaging studies can reliably diagnose this condition. Though the treatment depends upon the type and extent of involvement majority of the cases require appendicectomy and intravenous antibiotics. Morbidity, increased duration of hospital stay and complications are more common in perforated apendicitis than non perforated uncomplicated appendicitis having short duration of symtomps.