Abstract
Acute Appendicitis is a surgical emergency. Patients present with pain in right lower abdomen, with other symptoms like nausea/vomiting, fever, diarrhoea, urinary symptoms. Diagnosis is based on a multimodality approach that includes, clinical, radiological and pathological findings. Alvarado Score helps determine the severity of infection, confirm diagnosis and guide further management. Management is either conservative with antibiotics or surgical depending on severity. However approach to surgical management has changed with the ongoing Covid-19 pandemic. It has necessitated categorisation of surgical procedures into essential and non essential to limit risk to both patient and surgical team and also for prioritization of resources to the rising, continued spread of Covid-19. We present a prospective study of 25 cases of appendicitis presenting during the Covid Pandemic between 15th March and 30th May to our hospital, with an intent to try conservative management for all patients except in the presentations with complications like perforation, abscess or the presence of fecolith or poor response to conservative management.Patients not amenable to conservative management were treated by Open appendicectomy.
Highlights
Alvarado Score helps determine the severity of infection, confirm diagnosis and guide further management
We present a prospective study of 25 cases of appendicitis presenting during the Covid Pandemic between 15th March and 30th May to our hospital, with an intent to try conservative management for all patients except in the presentations with complications like perforation, abscess or testing, including Personal Protective Equipment (PPE) for operating team, limiting the members of operating team, proper operating room ventilation and air purification, dedicated Covid-19 positive and Covid-19 suspect wards, clear path for transport with limited traffic the presence of fecolith or poor response to conservative are the need of the hour
Alvarado Score is used to predict the severity of appendicitis, and uses clinical symptoms, signs and laboratory markers and negates the need for radiation exposure.[2]
Summary
It is the most common cause of acute abdomen in North America, with approximately 1/3rd presenting with perforation at presentation. Incidence is 84/100000 population.[1] CT is gold standard for imaging in acute appendicitis, associated with increased radiation exposure. Alvarado Score is used to predict the severity of appendicitis, and uses clinical symptoms, signs and laboratory markers and negates the need for radiation exposure.[2] Management of appendicitis is either conservative or surgical. Conservative management can be tried for non complicated appendicitis, whereas presence of complications like perforation, fecolith, abscess dictate surgical management.[3,4] the Covid-19 pandemic changes routine surgical management. Operating theatres are high risk areas for transmission, additional strain on the team and resources due to increasing
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