Delayed presentation and its effects on the prognosis of acute appendicitis

Abstract

Objective: To identify the causes of delay in the presentation of the cases of acute appendicitis and its effects on the prognosis. Study design: It was descriptive type of study. Place & duration of study: The study was conducted in Department of Surgery, Nishtar Hospital Multan in one year from February 2004 to January 2005. Patients & methods: The 50 patients of all ages and both sexes were taken from surgical wards of the hospital. They were presented with signs & symptoms of disease for more than 48 hours, but otherwise healthy i.e. not having any other serious illness. The patients were diagnosed as cases of acute appendicitis after history, examination, investigations and operation. Results: There were 4(8%) patients who did not take any treatment. Patients who took the treatment but wrongly diagnosed were 36(72%). Out of these 36 patients, 12(24%) patients were treated by the quacks, in 7(14%) the diagnosis was gastroenteritis, 11(22%) patients took antibiotics and analgesics from the start of the symptoms and in the remaining 6(12%) the presentation of the patients was not typical. 10 patients (20%) were diagnosed as acute appendicitis but they refused for appendicectomy. Out of these 50 cases 24(48%) were complicated. Overall perforation rate was 30%. Patient presenting with gangrenous appendicitis were about 6%. Appendicular mass formation was found in 4% cases. Patients presenting with generalized peritonitis were 6%. Appendicular abscess formation was in 2% cases. The duration of hospitalization was 3 days in uncomplicated cases, while in complicated cases it was 6.5 days. Conclusion: The high rate of complications of appendicitis with its subsequent sequelae of increased morbidity and resource expenditure is the result of patient`s delay in seeking medical attention.