Clinical Diagnosis and Pathology of acute Appendicitis


Abstract:Background:The diagnosis of acute appendicitis is essentially clinical, owing to the major complications of delayed appendecectomy which increases the risk of perforation and mortality rate. Even though such clinical diagnosis has an accuracy rate of 72-85% according to the histopathological evidence of acute appendicitis. Objective:The aim of our study is to compare our own results for this accuracy rate between clinical diagnosis and histopathological changes of acute appendicitis. Methods:A total of 107 appendices of patients (54 females and 53 males) admitted to Tikrit teaching hospital with a clinical diagnosis of acute appendicitis between November 2000 to August 2001. appendectomy was performed for them and all specimens were sent for histopathological study, and other surgical intervention has been done according to the clinical condition of the patient. Results:Histopathological results have been found as acute suppurative appendicitis in (68.22%), acute gangrenous appendicitis in (10.28%), and normal appendix in (21.50%). Most of inaccurate diagnosis was seen in females in which the pathology mimics the clinical presentation of acute appendicitis, while the most frequent type of appendicitis was acute suppurative appendicitis (68.22%) . Conclusion:The presence of neutrophils within muscularis propria represent primary acute appendicitis of probable clinical significance and other causes of abdominal pain should be sought in patients of mucosal and submucosal inflammation only. In addition, the patients with acute appendicitis is highly suggested by the presence of migratory abdominal pain, vomiting following right iliac fossa pain and tenderness on deep palpation and the surgeon can depend on these features to increase the accuracy rate of diagnosis. Obstruction and contrary to the popular belief is unlikely to be the primary cause of acute appendicitis.