ACUTE APPENDICITIS: THE DURATION OF THE DISEASE AND OF DYNAMIC OBSERVATION, CLINICAL DIAGNOSIS, PATHOLOGICAL CONCLUSION, DIAGNOSTIC TESTS (IN ONE CLINICAL HOSPITAL)

Abstract

Background. The typical symptoms of acute appendicitis (AA) may be absent in 20–33% of patients. If AA is suspected, dynamic observation, laboratory tests, and ultrasound examination of abdominal organs are performed. Objective – to evaluate the clinical presentation of AA at prehospital and hospital stages, to establish correlation of clinical diagnoses and histopathological findings, as well as the informativeness of laboratory and instrumental diagnostic methods for АA. Material and methods. 233 medical records of patients who underwent an appendectomy were analyzed. Results. The average time from hospital admission to surgery for chronic appendicitis is 8,3 ± 4,3 h, for catarrhal forms of AA – 7 .2 ± 2 h, for phlegmonous forms of AA – 4,5 ± 1h, for gangrenous forms of AA – 3,8 ± 1,2 h. The discrepancy between clinical diagnosis and histopathological conclusion was revealed in 56 cases (24%). In 14 cases, phlegmonous appendicitis, as evidenced by histopathological conclusion, had been considered to be catarrhal during surgery. For phlegmonous and gangrene appendicitis with the cut-off threshold for the white blood cell level of 9,0*109/l the sensitivity of the test reached 84,7%. An ultrasound scan detected gangrenous, phlegmonous and altered vermiform appendix (according to the histopathological conclusion) in 42% of cases. Conclusions. The time before surgery is inversely proportional to the degree of inflammation of the vermiform appendix. The intraoperative visual assessment of the vermiform appendix is not accurate. Routine diagnostic tests (white blood cell count and ultrasound examination) aren’t often useful for the detection of AA.