Clinical and pathological characteristics in acute complicated appendicitis / 中华外科杂志

ABSTRACT

<p><b>OBJECTIVE</b>To find out the clinical and pathological characteristics in acute complicated appendicitis.</p><p><b>METHODS</b>A retrospective clinical analysis was made on 742 cases of acute appendicitis from January 2003 to December 2012. All cases underwent appendectomy. Patients were allocated to the acute complicated appendicitis (ACA) group and the acute uncomplicated appendicitis group based on pathological reports. The χ² test was used to check for differences between proportions. Multivariate analysis was made through the Logistic regression.</p><p><b>RESULTS</b>Of 742 patients, 533 were allocated to the ACA group, including acute suppurative appendicitis 306 patients, acute gangrenous appendicitis 100 patients, appendicitis with perforation 59 patients, appendicitis with abscess formation 6 patients and appendicitis with tumor 5 patients. Statistical result shows that the patients of ACA group usually had higher total WBC count, local or diffuse muscle guarding, intraluminal stercolith or periappendiceal fluid. Logistic regression also indicated that ACA were mathematically related to high level white blood cell count (>20 × 10⁹/L, OR = 2.717, 95%CI 1.834-4.027, P < 0.05), local or diffuse muscle guarding (OR = 1.649, 95%CI 1.047-2.597, P < 0.05), intraluminal stercolith (OR = 2.939, 95%CI 1.607-5.377, P < 0.05) and periappendiceal fluid (OR = 3.273, 95%CI 1.424-7.525, P < 0.05).</p><p><b>CONCLUSIONS</b>Patients with high level WBC count, local or diffuse muscle guarding, intraluminal stercolith or periappendiceal fluid are likely suffering from acute complicated appendicitis. Appendectomy must be considered as first-line therapy other than conservative antibiotic therapy under these situations.</p>