Appendicitis Near Its Centenary

Abstract

In an analysis of the first 72 cases treated after the formulation of the appendicitis syndrome in 1886 compared with the experience from 1929-1959 and with 307 randomly selected recent cases, the major therapeutic trend has been an emphasis on appendectomy before perforation and abscess formation occur. The rate of infection nonetheless remains approximately 17%. Although the overall mortality rate has declined from 26% overall (40% for surgery) to 0.8%, the current rate of perforation is 28%, with a diagnostic accuracy of 82%. Among 13,848 patients from several reports the perforation rate increases linearly with diagnostic accuracy; therefore, a balance must be sought. Delay awaiting a diagnosis is a major determinant of perforation, but diagnostic aids are of limited help. Clinical acuity and prudent decisiveness are the keys to proper action.

Fatores de risco para as complicações após apendicectomias em adultos

“…Embora os índices de mortalidade atribuídos à apendicite terem diminuído acentuadamente no último século, as suas complicações continuam comuns 6 . Isto é atribuído ao fato das perfurações manterem-se freqüentes (17 a 20%) a despeito do aumento do uso dos métodos diagnósticos de ima- gens como a ultra-sonografia e a tomografia computadorizada, (2).…”

“…Houve uma dramática redução na mortalidade associada à apendicite aguda nos últimos 50 anos, de aproximadamente 26% para menos de 1% 6 . Entretanto, a morbidade não apresentou queda semelhante 6,7,8 , principalmente pela alta incidência de perfurações ainda existentes (17 a 20%), mesmo após o desenvolvimento dos métodos de diagnóstico por imagem 1,9 .…”

“…Entretanto, a morbidade não apresentou queda semelhante 6,7,8 , principalmente pela alta incidência de perfurações ainda existentes (17 a 20%), mesmo após o desenvolvimento dos métodos de diagnóstico por imagem 1,9 .…”

Combined use of modified Alvarado score and USG in decreasing negative appendicectomy rate

“…Overall, a negative appendicectomy rate of approximately 20% is commonly reported [2][3][4][5][6][7][8][9]. Nowadays commonly used diagnostic aids for appendicitis are CECT abdomen, laparoscopy, diagnostic scores, USG.…”

The diagnosis of acute appendicitis in pregnant versus non-pregnant women: A comparative study

“…4 Despite the tendency to late diagnosis of acute appendicitis during pregnancy, it is reported up to 23% of negative appendectomy rate. 5 However, a recent study reported that higher rates of adverse obstetric outcomes were observed amongst pregnant women with negative appendectomy. 6 Ultrasonography (USG) is a non-invasive and inexpensive test, which does not expose the patient to radiation, and is reported to have sensitivity and specificity of 86 and 81% for the diagnosis of acute appendicitis, respectively.…”