A Clinical Study of Appendicular Perforation

Abstract

INTRODUCTION: Acute appendicitis is the most common acute surgical condition of the abdomen. It is a fatal condition, and death occurs by sepsis due to peritoneal contamination with both aerobic and anaerobic organisms. The primary role of management is to control sepsis, minimize contamination, and treat the underlying cause. Surgery plays an essential role in the management of perforation. AIM: To analyse the incidence of appendicular perforation and to study the etiological factors. OBJECTIVES: To study the clinical presentation of appendicular perforation. To study various factors leading to appendicular perforation. To study the age & sex incidence. METHODOLOGY: In this study total of 20 patients were included, Patients of appendicular perforation are studied prosspectively in detail. Patients were selected from admissions in GEMS, Srikakulam. Clinical diagnosis of appendicular perforation is confirmed by investigations or by laparotomy performed. RESULTS: Out of the 20 patients , 14 patients were under the age of 20 yrs, 15 were males. One patient was in 1st trimester of pregnancy and underwent spontaneous abortion along with the appendicular perforation. 5 out of them were at the base of appendix and also has caecal perforation. One patient underwent cecostomy and temporary ileostomy. One patient needed right hemicolectomy as the patient has multiple perforations at the base of appendix and was in severe sepsis and succumbed to death on POD 3. CONCLUSION: Appendicular perforation was most common in younger age groups. Early appendectomy for perforated appendicitis significantly reduced the time away from normal activities, overall adverse event rate. Drain placement appears to be helpful with late diagnosis but is of little benefit when the duration of symptoms is less than four days. Thus it is likely that drains are most useful in patients with well established and localized abscess cavities.