International Clinical and Medical Case Reports Journal (ISSN: 2832-5788) | Volume 2, Issue 12 | Research Article | Open Access
Abeysinghe AHMGB*
Consultant surgeon, Senior Lecturer (MBBS, MS, FCSSL), Faculty of Medicine, Wayamba University of Sri lanka, Kuliyapitiya, Sri lanka
*Correspondence to: Abeysinghe AHMGB
Fulltext PDFIntroduction: Acute appendicitis is one of the common causes of acute abdomen which is mainly diagnosed on clinical assessment and simple laboratory investigations. The objective of this study was to determine the diagnostic accuracy of clinical judgment and its histopathological correlation.
Material and Method: A retrospective review of patient with a preoperative diagnosis of acute appendicitis was done at the department of surgery (unit B) at the teaching hospital Kuliyapitiya. It reviewed patients admitted from 1st of January 2020 to 30th of November 2020.Thus 108 patients with clinical diagnosis of acute appendicitis who underwent operative procedures were included. The histopathological reports were reviewed and correlated with clinical diagnosis. The operative observation of gross appearance of appendix were compared with histological reports.
Results: Out of 108 patients who underwent surgery, 79 (73.15%) patients were found to have some stage of appendicitis histologically. The most common intra-operative positive finding was acutely inflamed appendix which accounted for 56.48%. It was followed by suppurated appendix and complicated appendix accounting for 17.5 % and 12.0 % respectively. The age distribution of the patient series was between 7 years and 72 years with mean age 31.5 years. Sex distribution among male and female were 47.22% and 52.78% respectively showing female predominance. High white cell count seen in 79.50% patients with increased neutrophils in 65.74% patients. CRP was elevated among 70.50% patients. On gross appearance of the appendix intraoperatively 13.88 % had normal looking appendix and rest of the appendix showed various stages of inflammation ranging from simple appendicitis to complicated appendix.
Conclusion: Surgeon’s clinical skill and basic investigations are good enough in diagnosis of acute appendicitis when auxiliary diagnostic modalities are not available to enhance the diagnostic accuracy. Intra operative gross appearance along with the experience of the surgeon is enough to establish an accurate diagnosis. The final diagnosis must be made with the histology.
Appendicitis; Clinical diagnosis; Appendectomy; Histopathology
Abeysinghe AHMGB, Samarasinghe NR, Abeysinghe AHMCD, Wmalasena GADNB. Acute Appendicitis: Clinical Decision and Histopathological Correlation. Int Clinc Med Case Rep Jour. 2023;2(12):1-9.