Appendicitis Can Be Treated Safely with a Negative Appendectomy Rate of 10%

Abstract

The surgical literature supports a negative laparotomy rate of 20% for patients who are explored for the diagnosis of appendicitis. It has been assumed that attempts at decreasing the negative laparotomy rate will increase the perforation rate to above 25%. We reviewed the experience at a community hospital with the treatment of appendicitis in 970 consecutive patients. Close inhospital observation was used to evaluate difficult cases. The negative laparotomy and perforation rates were 10 and 23%, respectively. No patients perforated under observation. The surgical standards for negative appendectomy rate can be revised downward to 10% without fear of increasing the perforation rate.

What is Valentino's syndrome?

“…The first case report (without using the term referring to Valentino) may have been Britt's description, in 1966, of a perforated duodenal ulcer that presented with a retrocecal abscess that was managed initially as a complication of ‘appendicitis’ 35 . Coincident acute appendicitis and perforated peptic ulceration were initially reported in 1930 and only a few cases have been discussed in the literature 36 . Based on a review of several large retrospective series of appendectomies, the incidence of finding a normal appendix and perforated peptic ulcer disease (Valentino's syndrome) is approximately 0.3% 38–41 .…”

“…35 Coincident acute appendicitis and perforated peptic ulceration were initially reported in 1930 and only a few cases have been discussed in the literature. 36 Based on a review of several large retrospective series of appendectomies, the incidence of finding a normal appendix and perforated peptic ulcer disease (Valentino's syndrome) is approximately 0.3%. [38][39][40][41] The combined use of computed tomography scanning and diagnostic laparoscopy made Valentino's syndrome…”

Diagnostic Laparoscopy for Suspected Appendicitis

“…22 Because of the impressive increase in morbidity and mortality with perforation, a negative appendectomy rate of 10% 20% is still considered acceptable. 23 …”