Clinical profile of appendicitis with appendicolith and without appendicolith: our experience

Pawan Tiwari; Balvinder Singh; Dev Yadav; Akhil Kumar Kainth; Tushar Nagyan; Aditya; Pratul Arora; Priyanshu M. Varshney

Volume : VII, Issue : XII, December - 2018

Clinical profile of appendicitis with appendicolith and without appendicolith: our experience

Pawan Tiwari, Balvinder Singh, Dev Yadav, Akhil Kumar Kainth, Tushar Nagyan, Aditya, Pratul Arora, Priyanshu M. Varshney

Abstract :

Background: Acute appendicitis is the commonest reported emergency to surgical department worldwide. Knowing the clinical profile of appendicitis is important. Moreover, since appendicolith is the commonly cited aetiology for appendicitis, knowing its prevalence and its association with severity of disease is also important.

Methods: It was a retrospective study of patients who were operated for appendicitis or suspected appendicitis. All patients irrespective of age and sex were included. Each patient chart was studied for demographic details, nature of presentation, surgical approach used, details of intraoperative findings, postoperative complications and length of hospital stay.

Further, on the basis of intra operative findings patients were divided into two groups; Group A (appendicitis with appendicolith) and Group B (appendicitis without appendicolith) which were than compared for intraoperative findings/complications; postoperative period and length of hospital stay.

Results:

Out of 182 patients, only 128 patients were selected and studied. 64 %( 82) were males and 36 %( 46) were females, with male: female ratio of 1.8: 1. The mean age of the study population was 35.54 � 15.42 years (minimum 6, maximum 78). 89.8% patients (115/ 128) had acute presentation where as 10.2% (13/128) had chronic presentation. Right lower quadrant approach (Mcburney/Lanz/ Rutherford) was the commonest approach used for surgical intervention in 86.7% (111/128), followed by right lower paramedian in 10.2% (13/128) and lower midline in 3.1% (4/128). Position of appendix was retrocecal in ~61% (78/128) patients, followed by pelvic in 25% (32/128) patients, postileal in 4.7%(6/128), retrocolic in 3.1%(4/128), preileal in 2.3% (3/128), subcecal in 2.3% (3/128) and subhepatic in 1.6% (2/128) of the study population. Appendix was found inflamed in 85.9% (110/128) where as it was normal in 14.1% ( 18/128). Further, along with inflammation, appendix was perforated in 18.6% (24/128), gangrenous in 10.2% (13/128) and with pus/ abscess formation in 14.8% (19/128).

Appendicoliths were found in 14.1% (18/128). Most of the patients (10/18) had single appendicolith, 4 patients (4/18) had two appendicoliths, one patient had three appendicoliths (1/18); whereas three patients (3/18) had >3 appendicoliths. Most of the appendicoliths were <0.5 cm in size (along the long axis), three patients had appendicoliths of size 0.5– 1 cm, two patients had appendicoliths of size 1.1–1.5 cms; whereas single patient had a appendicolith of size 1.6–2 cms. Appendicoliths were mostly found in proximal third/ base of appendix (11/18) i.e. 61.1 % appendicoliths, at middle portion in (6/18) 33.33% and least at distal third or tip (1/18) in 1.6 % of appendicoliths. Postoperative complications was seen in (20/128) 15.6% patients.

Further, on comp� Group A (appendix with appendicolith) with Group B (appendix without appendicolith), it was observed that appendix was inflamed in 100% of patients in Group A as compared to 83.7% in Group B which is statistically not significant (P = 0.1374 ). The complications were also more common in Group A (i.e. perforation 44.4%, abscess/pus formation 38.9%, gangrenous changes 38.9%) as compared to Group B ( i.e. perforation 14.5%, abscess/pus formation 10.9%, gangrenous changes 5.5%) with P value of 0.0072 with respect to perforation which is statistically significant, P= 0.0062 for abscess/pus formation which is statistically significant, P= 0.0001 for gangrenous changes which is statistically significant. Post–operative complications during hospital stay were more in Group A i.e. 33.33% (6/18) than Group B i.e. 12.7 % (14/110) with P value= 0.0598 which is statistically significant. The average length of hospital stay was 6.44�2.11 days in Group A and 4.24�1.49 days in Group B.

Conclusion: Appendicoliths were present in 14.1 % of the patients operated for acute appendicitis. The complications were more frequent and severe in patients with appendicoliths on intraoperative findings than those without any appendicoliths; and as such patients with appendicoliths had more duration of hospital Stay. So patients with abdominal pain and presence of appendicoliths on radiological findings should be promptly subjected for surgical intervention to prevent complications and improve outcome