Appendicular Perforation Research Articles

Hyperbilirubinemia as a new predictor of appendicular perforation in acute appendicitis.

Objective: To find the diagnostic accuracy of hyperbilirubinemia as a prediction of appendicular perforation in acute appendicitis. Study Design: Cross Sectional study. Setting: Department of Surgery, Allama Iqbal Medical College/ Jinnah Hospital Lahore. Period: March 2019 to March 2020. Material & Methods: A total 345 patients meeting selection criteria were included. Serum bilirubin was measured pre-operatively and histopathology of specimen was collected. The data was analyzed using SPSS v 26 and mean ± SD, frequency and percentages were calculated. Results: There were 214(62%) males and 131(38%) females. On histopathology perforated appendicitis was seen in 70(20.3%) and 275(79.7%) cases had non-perforated appendicitis. A total of 77(22.3%) cases had hyperbilirubinemia and 268(77.7%) of the cases had normal bilirubin level. The sensitivity, specificity, PPV, NPV and diagnostic accuracy of hyperbilirubinemia was 90%, 94.91%, 81.82%, 97.39%, 93.91% respectively. Conclusion: The diagnostic accuracy of hyperbilirubinemia is high enough to identify early detection of perforated appendicitis. Hence, by early identification and appropriate management techniques, potentially life-threatening complications can be minimized.

Serum bilirubin as a diagnostic marker in acute appendicitis

Background- Acute Appendicitis is the most common cause of acute abdomen. The initial diagnosis of acute appendicitis is based on clinical history and physical examination. Objectives- To determine the relationship between hyperbilirubinemia and acute appendicitis and to evaluate the usefulness of Serum Bilirubin as a diagnostic marker for acute appendicitis. Methods-It was Prospective study. Patients admitted with clinical diagnosis of acute appendicitis under the Department of Surgery in Vinayaka Mission’s KirupanandaVariyar Medical College and Hospital, Salem from January 2020 to October 2021. Convenient Sampling (Non-Probability) was used. The sample size was 100. Chi- square or Fischer exact test was used as test of significance. SPSS (Version 16.0) was used. Results-The mean Age among the subjects was 25.04 years ranging from 8 to 70 years. Among the subjects, 59 (59%) were Males and 41 (41%) were Females. Among the subjects, 81 (81%) had Acute Appendicitis and 19 (19%) had Appendicular Perforation.the patients with Direct bilirubin > 0.3 mg/dl, 15 (18.75%) had Appendicular Perforation and among the patients with Direct bilirubin < 0.3 mg/dl, 4 (20%) had Appendicular Perforation. There is no difference in Appendicular Perforation among patients with Direct bilirubin > 0.3 mg/dl and <0.3 mg/dl (18.75% vs 20%).

Acute Appendicitis in Elderly Population a Study of the Various Risk Factors for Severity of Appendicitis

Appendicitis in the elderly continues to be a challenging surgical problem. Being a potential life endangering pathology. It accounts for 5% of all acute abdominal condition in people aged more than 65 years .Mortality rates being 16 times more when compared to a young adult with appendicitis and complication rates like perforation being as high as to 70% as the disease presents with Vague symptoms and with a more virulent pathologic course that allows rapid progression of the disease which leads to delayed hospitalization, diagnosis, treatment and increased morbidity and mortality. Material and Methods - A 5 year retrospective cross sectional Chart review was done to collect information on patient’s above 60 years of age who had undergone appendicetomy .Demographic data , clinical presentation ,delay in hospital arrival and co morbid condition ,usg and intra operative findings noted and analysed Results:- Out of 111 elderly patients, 71 males and 40 females with a mean age of 69.8 years, 88 had hypertension,62 with diabetes , 19 ckd . 61 proved to have perforated appendicitis, 37 males and 24 females with significant delay in hospital arrival duration of 2-7 days .Perforation rates were increased in patients with multiple comorbities (diabetes, hypertension,ckd) and delay in hospital arrival. Conclusion: A high index of suspicion is needed in elderly patients with acute abdomen to prevent misdiagnosis. Delay in presentation to the hospital and multiple comorbidities are the main risk factors associated with higher rates of appendicular perforation.

Conservative Management in Acute Appendicitis is it Superior to Surgery? A Retrospective Study

To see the merits of the surgical treatment and hence to reaffirm the superiority of surgery in acute appendicitis. Background: Surgery was the treatment of choice for acute Appendicitis which was practised over centuries. During the last decade, there were some publications about the conservative management of uncomplicated acute Appendicitis in adults and its advantages over the surgery. And all that studies also states that there was recurrence of about 20-30 %. Methods: The data of patients that came to the surgical department with acute appendicitis and recurrent appendicitis during the period November 2020 to December 2021 were analysed. The patients treated with surgery alone were included in the study. Detailed history, laboratory investigations and radiological investigation including Ultrasonogram (USG) were analysed to differentiate acute and recurrent cases. From the data we could identify the number of both acute and recurrent cases. Hospital admissions, number of episodes for the recurrent treatment, loss of working days and other relevant data were collected from the patients. Results: There were 61 patients who were operated for appendicitis including both acute and recurrent cases in the period of 1 year in the COVID era. Among these 34 were acute appendicitis and 27 recurrent appendicitis. Male: Female ratio was 39:22. Our study shows that majority are male patients and the most numbers are in the age group 10-30 years comparable to the standard statistics. Our study shows that 44.26% (27) of the total cases (61) operated was recurrent appendicitis. The number of recurrent episodes varied from the period of 1 week to 2 years after conservative treatment". In them treatment also varied from outpatient to inpatient in different individuals. The advantage of less hospital stays and decreased morbidity of conservative treatment is lost with subsequent investigation and surgical treatment in those. All the patients who got operated on follow up had an uneventful post operative period. Conclusion: So conservatively managed patients had lost many working days and had economic loss compared to patients operated for acute appendicitis early. Early surgery in acute appendicitis actually decreased the cost and morbidity. Keywords: Acute appendicitis; Recurrent Appendicitis; Appendicectomy; Conservative treatment; Appendicular perforation.

Amyand’s Hernia: Case Report and Therapeutic Strategy

Amyand's hernia corresponds to an appendix contained in an inguinal hernia sac. Its frequency in the literature varies between 0.2 and 1.7% and the presence of associated acute appendicitis is extremely rare. The most formidable complication is severe peritonitis secondary to appendicular perforation. The surgical intervention consisted of a reintroduction of the appendix intra abdominally, and resection of the hernial sac, then, a cure of the hernia with placement of a prosthesis. The postoperative consequences were simple. Questions remain as to its pathophysiology, clinical particularity and treatment. More research and evidence is needed, which will be difficult to achieve due to the rarity of Amyand's hernia.

Hyperbilirubinemia as a Possible Predictor of Appendiceal Perforation in Acute Appendicitis: A Prospective Study.

Introduction: Acute appendicitis, a common abdominal surgical emergency, can mostly be diagnosed clinically by assessing the symptoms and physical findings but confirmation of the diagnosis solely depends upon the histopathological study of the resected appendix specimen, being supplemented by a few laboratory tests and ultrasonography (USG). In spite of all these available investigations, the diagnosis of acute appendicitis, because of its nebulous presentation and the variability of signs, remains a Herculean task for the surgeon.Methods: This is a prospective study conducted on 125 patients diagnosed with acute appendicitis and posted for appendicectomy. Total serum bilirubin (TSB), and total leucocyte count (TLC) were done in all cases. USG of the abdomen was done in all the cases to confirm the diagnosis and to rule out other causes of acute abdomen. TLC more than 11 x 103 cells/µL and TSB more than 1.1 mg/dL were considered positive. They were operated on and their diagnoses were confirmed post-operatively by histopathological examination. Patients were subdivided according to histopathological findings into: normal appendix (n = 11), uncomplicated acute appendicitis (n = 86), gangrenous appendicitis (n = 10) and perforated appendix (n = 18). Laboratory results, operative findings, and histopathological findings were compiled, analyzed, and compared with reference values.Results: Out of 125 patients, 114 (91.2%) were histologically positive for acute appendicitis, while 11 (8.8%) had normal histology. TLC was elevated in 95 (76 %) patients and it was normal in 30 (24%) cases. Among the patients with leucocytosis, only 90 (94.74%) had positive histology for acute appendicitis, while the remaining five (5.26%) had normal histology. Among the 30 patients who had normal TLC, 24 had positive histology for acute appendicitis, while the remaining six had normal histology. The specificity, sensitivity, positive predictive value (PPV), and negative predictive value (NPV) were 78.95%, 54.55%, 94.74%, and 20%respectively. Similarly, 67 patients (53.6%) had elevated TSB, while it was within normal limits in 58 (46.4%) patients. From the patients with hyperbilirubinemia, 65 (97.01%) had positive histology for acute appendicitis, while the remaining two (2.99%) had normal histology. Among 58 patients who had normal TSB, 49 had positive histology for acute appendicitis, while the rest nine had normal histology. The specificity, sensitivity, PPV, and NPV are 57.02%, 81.82%, 97.01%, and 15.52% respectively. However, when both TLC and TSB were compared as markers of appendicular perforation, the sensitivity, specificity, PPV, and NPV of total serum bilirubin were found to be 89.29% against 21.43%; 53.49% vs. 2.33%; 38.46% vs. 6.67% and 93.88% vs. 8.33% of total leukocyte counts respectively.Conclusion: Elevated total serum bilirubin could be used as a better predictor of appendiceal perforation in acute appendicitis.

A Retrospective Analysis of Conservative Management Versus Early Surgical Intervention in Appendicular Lump.

IntroductionAcute appendicitis happens to be increasingly common in school-going children and early part of adult life, peak incidence reaching in the teens and early twenties. Luminal obstruction of the vermiform appendix is thought to be essential for the development of appendicular ischemia, gangrene, and perforation. The treatment of choice in acute appendicitis is emergency appendectomy. Appendicitis particularly puts the surgeon in a dilemma whenever the patient presents late by around four to seven days. In case of delay in presentation, complications like appendicular lump formation occur. The factors that make the clinical presentation inconsistent which in turn makes the diagnosis challenging in the case of acute appendicitis are the variable position of the appendix, the degree/grade of inflammation, and the age of the patient.At present, the standard treatment is the Ochsner-Sherren regimen universalized by Oschner and has been mostly practised over many decades as the standard care for the appendicular lump. Conservative regimen does not work in a few cases where urgent surgical exploration is necessary. This study was conducted to compare early appendectomy versus conservative management followed by interval appendectomy in case of appendicular mass and to make a better strategy for effective management of patients with complicated appendicitis.MethodsA total of 112 patients were diagnosed as having an appendicular lump as per the available records between June 2018 and June 2021. The total study population was divided into two comparative groups depending upon the treatment they received. The patients in group-1 received medical treatment and those in group-2 had undergone surgical management. The patients in group-1 were treated according to the Ochsner-Sherren regimen. The patients in group-2 were the patients in whom emergency appendectomy was done. If the general condition of the patient did not improve, pain and tenderness didn’t subside, the size of phlegmon or abscess was increasing and other features of the acute abdomen were persistent, then it was regarded as a failure of medical treatment and the patient was prepared for surgery on an emergency basis.ResultsOut of 1192 cases of acute appendicitis admitted between June 2018 and June 2021, a total of 112 patients were diagnosed with an appendicular lump. As per the record, 64 patients were managed conventionally as per the Ochsner-Sherren regimen followed by elective interval appendectomy (group-1) and 48 cases were managed with an emergency surgical procedure (group-2).In group-1, out of 64 patients, non-operative treatment was successful in 58 patients (90.62%). Among the remaining patients, there was a failure of non-operative treatment in six patients and they were subjected to emergency surgical exploration (9.37%). So a total of 58 patients underwent interval appendectomy after six weeks. Out of 54 patients who had undergone emergency appendectomy in both groups, the per-operative finding was an appendicular lump in 55.5% of patients while a total of 44 patients in group-2, were discharged from the hospital within six days (91.66%). But in group-1, only 16 patients were discharged from the hospital within six days (25%), rest were discharged from the hospital after more than seven days of stay.ConclusionEarly appendectomy in appendicular mass is safe due to the improvements in surgical techniques and better postoperative care.

Acute appendicitis in pregnancy

Acute appendicitis is the most frequent non-obstetrical surgical emergency encountered in pregnancy with negative maternal and fetal outcomes, mostly attributed to appendicular perforation. The purpose of this article is to discuss the characteristics in diagnosing appendicitis in pregnancy, recommendations of management, as well as maternal and fetal outcomes. It is significantly challenging to diagnose appendicitis in pregnancy due to the anatomic displacement of the appendix caused by the enlargement of the uterus (which may cause uncommon symptomatology), the physiologic leukocytosis of pregnancy, the raised prevalence of abdominal discomfort along with the inability to perform computed tomography because of the radiation exposure of the fetus. These particularities may delay an accurate and timely diagnosis which is of utmost importance in order to avoid the significant complications associated with peritonitis. Rapid surgical intervention (especially laparoscopy) is recommended, nevertheless, the key in managing appendicitis in pregnant patients is finding a balance between the risk of delaying the diagnosis and consequent perforation against the risk associated with a negative appendectomy.

An Audit on Gastrointestinal Perforation in a Tertiary Care Teaching Hospital Based in Northern Part of India: A Study of 100 Cases

Background: A prospective study was conducted on 100 patients of perforation peritonitis: To find out the incidence of gastro intestinal perforation in various age groups, sex, riral or urban, socio economic status, To find out the various causes and sites of gastra intestinal perforartions, To determine various types of procedures being done to treat gastro intestinal perforations.Methods:The study population consisted of 100 patients of perforation peritonitis admitted at surgical wards of Rajindra Hospital, Patiala. Patients underwent necessary investigations such as Blood counts, biochemical analysis and urine analysis. X-ray Abdomen and chest / USG Abdomen/Pelvis CT-Abdomen (as and when required). All diagnosed patients were subjected to surgery. In all cases, operative findings and postoperative course were followed up for three months. Final outcome was evaluated on the basis of clinical, operative and radiological findings. In pre-pyloric and duodenal perforation, GRAHAM’S PATCH REPAIR carried out. In Ileal and Jejunal perforations, primary closure or exteriorization done depending upon the condition of the gut and duration of the symptoms. The patient outcome was assessed by duration of hospital stay, wound infection, wound dehiscence, leakage/entero-cutaneous fistula, intra-abdominal collection/abscess, ileostomy related complications and reoperation. Wound infection was graded as per SSI grading.Results:Most common age group for perforation was 21-40 years (50%) followed by 41-60 (33%) years in present study. Mean age of the patients is 37.91 + 13.15 years with male predominance (78%) in our study. 4% of the patients were of upper socio-economic status while 32% of the patients were of middle and 64% of the patients were of lower socio-economic status.Abdominal pain was seen in 100% of the patients while abdominal distension was present in 69% of the patients. Nausea/Vomiting was seen in 61% of the patients while Fever and Constipation was seen in 53% and 86% of the patients respectively. Diarrhoea was seen in 3% of the patients. Tenderness, guarding & rigidity, distension, obliteration of liver dullness and evidence of free fluid were present in 100% of the patients. Bowel sounds were not detected in all the patients. Most common perforations were Duodena(37%), Ileal (25%), Gastric (25%) followed by Appendicular (9%), Jejunal (4%) and Colonic perforation (2%). The most common etiology of gastrointestinal perforations was Peptic ulcer followed by Typhoid, Appendicitis, Tuberculosis, Trauma, Malignancy and non-specific infection.In Gastric perforations, Peptic ulcer was the most common cause of perforation followed by Trauma. In Ileal perforations, Typhoid was the most common cause of perforation followed by Tuberculosis and non-specific infection. In Appendicular perforations, most common cause was Appendicitis. In Jejunal perforations, most common cause was Trauma. In Colonic perforations, most common cause was Malignancy.Conclusions:The incidence of gastrointestinal perforations was common in 21-40 years age group followed by 41-60 years age group with male preponderance in our study. The most common site of perforations was Gastro-duodenal followed by Ileal perforations and the most common cause for these perforations was peptic ulcer followed by typhoid. The most common procedure done to treat gastrointestinal perforations was primary closure, resection and anastomosis, appendectomy and stoma formation. However, small sample size and short follow up period were the limitations of the present study.

EVALUATION OF HYPERBILIRUBINEMIA IN PATIENTS WITH APPENDICULAR PATHOLOGY

Background: The physiological obstruction of the bile flow associated with appendicular pathology leads to hyperbilirubinemia, which can be used as a predictive factor of appendicular perforation. Objective/Aim : Primary objective of this study was 1. To evaluate hyper-bilirubinemia associated with appendicular pathology. Secondary objectives of this study were 1. To evaluate elevated bilirubin level as an additional diagnostic marker for severity of acute appendicitis. 2. To evaluate whether elevated bilirubin levels have a predictive potential for the diagnosis of appendicular perforation. Methods: The study was conducted in the department of Surgery, Central Referral Hospital, associated to Sikkim Manipal Institute of Medical Sciences, Gangtok. The study was designed as a prospective observational study spanning over a time of 12 months, with enrolment of patients from 12.05.2016 to 11.05.2017. A total of 52 patients with clinical diagnosis of features of acute appendicitis or appendicular perforation admitted in the surgical ward were included. Results: Patients with appendicular perforation (n=14) were divided based on location of perforation:9(64.3%) had perforation at apex, 2(14.3%) at base and 3 (21.4%) had perforation at the body of appendix. Patient who had perforation at the apex of appendix had a mean total bilirubin of 1.84 mg/dl, 7 (77.8%) of these patients had elevated total bilirubin while an equal number had elevated direct bilirubin. Two (22.2%) had normal total bilirubin and value. Patients having perforation at base had a mean total bilirubin of 1.11 mg/dl and direct bilirubin of 0.56 mg/dl. Though one of these had elevated total bilirubin the other had normal value. On the other hand, both had elevated direct bilirubin. The patients having perforation on the body of appendix had mean total bilirubin and direct bilirubin 1.51 mg/dl and 0.57 mg/dl respectively. Both these patients had elevated total bilirubin and direct bilirubin. It was found that both total and direct bilirubin increased in cases having perforation of appendix, but these elevations was not statistically significant. Conclusions: Based on the data obtained, the bilirubin levels cannot be used as an indicator for: a) Severity of acute appendicitis b) appendicular perforation.

Acute Appendicitis During Coronavirus Disease 2019 (COVID-19): Increasing Incidence of Complicate Appendicitis, Severity and Length of Hospitalization.

COVID-19 is rapidly spreading, and due to the high morbidity and mortality caused by the pandemic many Governments have introduced social restrictions. Those measures combined with infection-related patient anxiety, led to hiding other diseases. The aim of this study was to evaluate the impact of COVID-19 on numbers and severity of acute appendicitis cases referred during the pandemic. Between March 2019 and March 2021, all patients who underwent appendectomy in Tor Vergata Hospital, Rome were included. Patients were divided in two groups (COVID-19/pre-COVID-19). Clinical features, intraoperative findings, hospital stay, and histologic examination data were included in the retrospective analysis. Out of 334 admitted patients, 36 (10.7%) had a diagnosis of acute appendicitis (COVID-19 group) vs. 59(11.2%) in the pre-COVID-19 group. The COVID-19 group presented significantly longer hospitalization, incidence of appendicular abscess, perforation, and severity of inflammation at univariate analysis p=0.002, p=0.021, p=0.001, p=0.006, p=0.001, respectively. At multivariate analysis, appendicular abscess (p=0.015) and higher serum levels of C reactive protein (p<0.008) were associated with prolonged hospital stay. This study highlights the correlation between COVID-19 pandemic and the severity of acute appendicitis presentations.

Diagnostic Accuracy of Alvarado Score in Diagnosis of Acute Appendicitis in Patients with Acute Pain Right Iliac Fossa

Background: The gold standard treatment of acute appendicitis is appendectomy. Early surgery reduces a number of complications such as appendicular mass formation, abscess and perforation. However, diagnostic inaccuracy especially in female gender can lead to negative appendectomy because other gynecological diseases have quite similar presentation. The objective of our study is to determine the diagnostic accuracy of Alvarado scoring system in the diagnosis of acute appendicitis in comparison to the gold standard histopathology in patients with acute pain right iliac fossa. Methods: This descriptive Cross-sectional study was carried out on 253 patients with acute pain in right iliac fossa at Surgical Department of MTI, Lady Reading Hospital from 14th July 2020 to 14th January 2021. Results: Mean age was 37 years with standard deviation ± 10.09. 111(44%) patients were male and 142(56%) patients were female. 129(51%) patients were married while 124(49%) patients were unmarried. Based on Alvarado scoring Acute appendicitis was diagnosed in 197(78%) patients and missed in 56(22%) patients. Diagnosis of Acute appendicitis was confirmed by histopathology report in 245(97%) patients while in 8 (3%) patients histopathology did not reveal acute infection. Diagnostic accuracy of Alvarado scoring analyzed with histopathological diagnosis was 78.65%. Conclusion: Alvarado scoring has a sensitivity of 79.18%, specificity 62.5%, PPV 98.47%, NPV 8.92% and diagnostic accuracy of 78.65% in diagnosis of acute appendicitis taking histopathology as gold standard in patients with acute pain right iliac fossa. Keywords: Acute Appendicitis, Alvarado, Histopathology, Diagnostic accuracy

USING 2MM TITANIUM MINIPLATES AND 3D LOCKING PLATE IN THE TREATMENT OF SYMPHYSIS AND PARA-SYMPHYSIS FRACTURE OF MANDIBLE

Introduction: In India, the most frequent surgical emergency is perforation peritonitis. Despite improvements in surgical methods, antimicrobial therapy, and critical care support, peritonitis treatment remains a very demanding, challenging, and complicated task. The highest dependability on the Risks' assessment is achieved by MPI, enabling the individual prognosis of peritonitis patients to be predicted.&#x0D; Objectives: The goal of the current research was to use Mannheim's Peritonitis Index to assess the prognosis for patients with perforation peritonitis.&#x0D; Results: In the current research, we found that the majority of the participants were men (65.38%) and that the bulk of the cases belonged to the 46-55 year age group (25%), which was followed by the 36-45 year age group (23.07%). The most common perforation found in the patients was duodenal (42.30%), which was followed by appendicular (13.46%), gastric (28.84%), fileal (9.61%), jejunal (3.8%), and colonic perforations (1.9%).&#x0D; Conclusion: The majority of research participants (46.15%) reported MPI scores between 21 and 29, followed by situations where the MPI score was more than 29, and cases where the MPI score was less than 21, in that order (38.46%).

Acute Appendicitis in Pregnancy: Our Experience in Rural Area

Acute appendicitis is the most prevalent non-obstetric surgical emergency in pregnant women. The diagnosis gets more challenging when the anatomical location of the appendix shifts due to the expansion of the gravid uterus. In cases of appendicular perforation, there is a higher risk of feto-maternal morbidity and mortality, so prompt and accurate diagnosis and treatment are essential. The goal of this study is to look into the clinical signs and symptoms of acute appendicitis in pregnancy, as well as how to treat it.

“A COMPARATIVE STUDY OF RIPASA SCORE AND ALVARADO SCORE IN THE DIAGNOSIS OF ACUTE APPENDICITIS”

Acute appendicitis is the most common condition encountered in the Emergency department .Alvarado and Modied Alvarado scores are the most commonly used scoring system used for diagnosing acute appendicitis.,but its performance has been found to be poor in certain population . Hence our aim was to compare the diagnostic accuracy of RIPASA and ALVARADO Scoring system and study and compare sensitivity, specicity and predictive values of these scoring systems. The study was conducted in Government district hospital Nandyal . We enrolled 176 patients who presented with RIF pain . Both RIPASA and ALVARADO were applied to them. Final diagnosis was conrmed either by CT scan, intra operative nding or post operative HPE report. Sensitivity,specicity, positive predictive value, negative predictive value, diagnostic accuracy was calculated both for RIPASA and ALVARADO. It was found that sensitivity and specicity of the RIPASA score in our study are 98.7% and 83.3%, respectively. PPV and NPV were 98.1% and 88.2% and sensitivity and specicity of the Alvardo score in our study are 94.3% and 83.3%, respectively. PPV and NPV were 98% and 62.5%.Diagnostic accuracy of RIPASA score and Alvarado score are 97% and 93% respectively. RIPASA is a more specic and accurate scoring system in our local population when compared to ALVARADO . It reduces the number of missed appendicitis cases and also convincingly lters out the group of patients that would need a CT scan for diagnosis (score 5-7.5 ) BACKGROUND: Acute appendicitis is one of the most commonly dealt surgical emergencies, with a lifetime prevalence rate of approximately 1 one in seven. The incidence is 1.5–1.9 per 1,000 in the male and female population, and is approximately 1.4 times greater in men than in women. Despite being a common problem, it remains a difcult diagnosis to establish, particularly among the young, the elderly and females of reproductive age, where a host of other genitourinary and gynaecological inammatory conditions can present with signs and symptoms that are 2 similar to those of acute appendicitis. A delay in performing an appendectomy in order to improve its diagnostic accuracy increases the risk of appendicular perforation and peritonitis, which in turn increases morbidity and mortality. A variable combination of clinical signs and symptoms has been used together with laboratory ndings in several scoring systems proposed for suggesting the probability of Acute Appendicitis and the possible subsequent management pathway. The Raja Isteri Pengiran Anak Saleha Appendicitis (RIPASA) and ALVARADO score are new diagnostic scoring systems developed for the diagnosis of Acute Appendicitis and has been shown to have signicantly higher sensitivity, specicity and diagnostic accuracy. AIMS AND OBJECTIVES PRIMARY OBJECT 1. To compare RIPASA Scoring system and ALVARADO Scoring system in terms of diagnostic accuracy in Acute Appendicitis. 2. To study and compare sensitivity, specicity and predictive values of above scoring systems. SECONDARY OBJECT 1. To study the rate of negative appendicectomy based on above scoring systems. CONCLUSION: The RIPASA score is a simple scoring system with high sensitivity and specicity for the diagnosis of acute appendicitis. The 14 clinical parameters are all present in a good clinical history and examination and can be easily and quickly applied. Therefore, a decision on the management can be made early. Although the RIPASA score was developed for the local population of Brunei, we believe that it should be applicable to other regions. The RIPASA score presents greater Diagnostic accuracy and Sensitivity and equal specicity as a diagnostic test compared to the Alvarado score and is helpful in making appropriate therapeutic decisions. In hospitals like ours, the diagnosis of AA relies greatly on the clinical evaluation performed by surgeons. An adequate clinical scoring system would avoid diagnostic errors, maintaining a satisfactory low rate of negative appendectomies by adequate patient stratication, while limiting patient exposure to ionizing radiation, since 21 there is an increased risk of developing cancer with computed tomography, particularly for the paediatric age group.

Surgical management and perioperative complications of peritonitis secondary to hollow viscus perforation in a tertiary care centre

Background: High mortality and morbidity is associated with peritonitis secondary to hollow viscus perforation, proving it a most common life threatening condition which needs emergency surgical care. Hence a proper evaluation was needed regarding appropriate management to have a better outcome, which was a challenge to operating surgeon.Methods: A serial study of 96 cases of peritonitis secondary to hollow viscus perforation was conducted at tertiary care centre, department of general surgery, Mysore medical college and research institute, Mysore, Karnataka from the period of August 2020 to July 2021. Data related to aetiology, surgical intervention and its peri-operative complications were noted. Appropriate statistical analyses were done to draw the inference.Results: Out of 96 cases studied, 74 were male, 22 were female with mean age of 45.53 years. Most common cause of peritonitis was GU perforation, followed by idiopathic, infective, malignancy, appendicular perforation and Trauma.Conclusions: Hollow viscus perforation being most common surgical emergencies, surgical outcomes and its related complications depends on age, general condition, site, co-morbidities and aetiologies.

Spectrum of gastrointestinal perforation peritonitis in 462 consecutive patients in tertiary care institute of North India

Background: Gastrointestinal perforation is one of the common surgical emergencies in developing countries. The diagnosis is mainly clinical and is aided by radiological investigations. This study was designed to highlight the spectrum of hollow viscus perforation peritonitis in terms of etiology, clinical presentations, site of perforation, surgical treatment, postoperative complications, and mortality.Methods: The study was a hospital‑based observational study and included 462 patients of perforation peritonitis (diffuse or localized) who were studied retrospectively in terms of cause, site of perforation, surgical treatment, complications, and mortality. Only those patients who underwent exploratory laparotomy for management of perforation peritonitis were included.Results: Overall stomach was the most common site of perforation (33%). Ileum (26%) was the second common site of perforation. Duodenal perforations were seen in 88 (19%) cases whereas appendicular perforations were seen in 46 (10%) cases. Colonic perforations were least common. Acid peptic disease was the most common etiology of stomach perforations. Enteric fever (63%) was the most common etiology of jejuno-ileal perforation. Other causes include tuberculosis (23%), trauma (8%), malignancy (3%) and idiopathic in rest. Males were six times more commonly affected than females. Peak incidence was noted in the 2nd and 3rd decades of life.Conclusions: Spectrum of perforation peritonitis cases in developing world is different from developed countries The Western literature suggests that foreign body, ischemia, radiotherapy, diverticula, and Crohn’s disease are the main causes of perforations. In contrast to this, infection is the most common cause for perforations in developing countries.

A Comparative Study of Hyperbilirubinemia in Predicting Appendicitis and its Complications

Background: Acute appendicitis is the most common general surgical emergency in young adults. Diagnosis of Appendicitis still remains a dilemma in spite of the advances in various laboratory and radiological investigations. Importance of hyperbilirubinemia or elevated Serum Bilirubin and its association in acute appendicitis and its complication as been postulated recently. The present study was undertaken to assess relationship between hyperbilirubinemia in predicting appendicitis and its complication. Methods: The present study was conducted in the Department of Surgery, SIMS &amp; RH ,Tumkur during the period of August 2019 to August 2020. A total of 100 patients with clinical diagnosis of acute appendicitis or Appendicular perforation were studied. The serum bilirubin and LFTs were carried out in all the patients. Results: In this study, males (56%) outnumbered females (44%). Of the 100 patients, 91% were diagnosed as acute appendicitis clinically while 9% were diagnosed with Appendicular perforation. Postoperatively 82% were confirmed as acute appendicitis while 18% were diagnosed with Appendicular perforation. Of 82 patients with acute appendicitis, 74.39% had raised bilirubin levels, while 25.6% had normal levels. 18 patients were diagnosed as Appendicular perforation, 15 patients (83.33%) had raised bilirubin levels, while the remaining 03 patients (16.66%) had normal levels. Conclusion: The Sensitivity and Specificity of serum bilirubin as a marker in predicting acute appendicitis and Appendicular perforation was 74.39% and 83.33% respectively.Serum bilirubin levels appears to be a promising new laboratory marker for diagnosing acute appendicitis, however diagnosis of appendicitis is essentially still - clinical. Patients with clinical signs and symptoms of appendicitis and with hyperbilirubinemia double the normal range (Raise in Direct Bilirubin being still higher) should be identified as having a higher probability of Appendicular perforation suggesting, serum bilirubin levels have a predictive potential for the diagnosis of Appendicular perforation.

A study of non-traumatic gastrointestinal perforations in a tropical country

Background: Gastrointestinal perforations constitute one of the commonest surgical emergencies encountered by surgeons all over the world. However, non traumatic gastrointestinal perforations are more commonly seen in tropical countries. They cause considerable mortality and usually require emergency surgery. This study was designed to study the clinical spectrum of non traumatic gastrointestinal perforation in a tropical country and thereby assessing the surgical outcome.Methods: An observational study was conducted in the department of general surgery, Mamata medical college, Khammam to analyse the clinical spectrum and their management protocol with outcome of the patients presenting with non traumatic gastrointestinal perforation. A total number of 140 patients of various etiologies of non traumating gastrointestinal perforations were found to be treated over a period of six years. Detailed demographic profile, clinical presentations and etiological factors were studied along with various management protocols offered to them with the outcome.Results: Most common age of presentation was 41-60 years with 72%being males. Most common site of perforation was duodenum (28.57%) followed by stomach (25%). Peptic ulcer (53.57%) was the predominant etiology followed by appendicular perforation (15.71%), enteric perforation (12.85%), tubercular (4.28%), malignancy (1.42%) and diverticula (0.71%). Most common post-operative complication was wound infection (37.14%) followed by dyselectrolytaemia (31.42%). Mortality was 7.14%.Conclusions: Gastrointestinal perforations constitute one of the commonest surgical emergencies. Non traumatic gastrointestinal perforations are quite common in a tropical country like India. The high rates of mortality among those, who present late, prompt an early diagnosis and active management protocol in order to reduce mortality and morbidity in such patients.

Complications of appendicitis in a tertiary care centre

Background: Acute appendicitis is the most common surgical emergency. An appendicectomy is considered the gold standard of treatment for acute appendicitis because of the potential risk of disease progression to perforation, gangrene and peritonitis. The aim of this study was to determine the incidence of complications in patients diagnosed with acute appendicitis.Methods: A total number of 70 patients were studied with various symptoms of acute appendicitis and their complications, all patients were presented to PESIMSR, Kuppam from December 2016 to June 2018. Clinical assessment , investigations like WBC counts, X-ray erect abdomen, USG abdomen and pelvis and management were recorded. The incidence of complications were studied. The cases of appendicular mass was treated conservatively, except for those who do not respond to antibiotics.Results: During this study period, among 70 patients aged between 5-45 years, male were 53 and female patients were 17 and 11 patients belong to pediatric age group and 59 patients aged more than 18 years. The commonest complication was postoperative surgical site infection (20%) found in perforated appendix patients in our study. Around 76% of the patients developed complications. Among the female patients diagnosed with acute appendicitis, appendicular perforation being the most common complication and it was the postoperative surgical site infections in males.Conclusions: Acute appendicitis is the most common surgical emergency. Open appendicectomy is the most commonly done procedure in our hospital. The commonest complication is postoperative surgical site infection (20%) found in perforated appendix patients in our study.