Hong Kong Med J 2010;16:12–7 | Number 1, February 2010
If not appendicitis, then what else can it be? A retrospective review of 1492 appendectomies
KW Ma, NH Chia, HW Yeung, MT Cheung
Department of Surgery, Queen Elizabeth Hospital, 30 Gascoigne Road, Kowloon, Hong Kong
OBJECTIVE. To audit the appendectomies at our institute, and summarise atypical pathological results with a discussion of appropriate management.
DESIGN. Retrospective study.
SETTING. Regional hospital, Hong Kong.
PATIENTS. All patients who underwent appendectomy for presumed acute appendicitis from June 2003 to June 2008 were recruited. Incidental appendectomy was excluded. Patient demographics, pathological findings, and surgical outcomes were analysed.
RESULTS. The overall negative appendectomy rate was 18.2%. Female patients of reproductive age (11-50 years) conferred an independent risk for a higher negative appendectomy rate than other females (28.7% vs 11.5%; P70 years) conferred an independent risk of perforated appendicitis (25.2% vs 16.3%; P=0.002). Preoperative imaging was not associated with a lower negative appendectomy rate or rate for perforated appendicitis (P=0.205 and 0.218, respectively). Multivariate analysis suggested that a preoperative white cell count of less than 13.5 x 10(9) /L was an independent predictor of negative appendectomy (P
CONCLUSIONS. A more focused utilisation of preoperative imaging in females of reproductive age and patients at the extremes of age is suggested. Long-term follow-up should be offered to patients with granulomatous appendicitis and neoplastic appendiceal diseases.
Key words: Appendectomy; Appendicitis; Diagnostic errors; Diagnostic imaging; Granuloma
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