A prospective clinical study of the effects of the physical features of the appendix on perforation

BACKGROUND: Acute appendicitis (AA) is one of the most common surgical emergencies, whosepostoperative morbidity and mortality increase significantly when the appendix perforates. The identification of factors that lead to perforation in these patients might effectively reduce morbidity. In this study, factors associated with perforation in AA were examined.
METHODS: The study included sixty patients divided into equal non-perforated and perforated groups. Preoperative body mass index (BMI) and prehospital delay of the patients, the appendix location, presence of fluid or abscesses during surgery, and the appendix wall thickness, root and end diameters, and length in the surgery specimen were compared.
RESULTS: The patients were comprised of forty males and 20 females, with a median age of 27 (range 16–84) years. BMI was significantly higher in the perforated group than the non-perforated group (p=0.039). There was no difference between the groups in terms of the presence of fluid (p=0.792); the presence of abscess was higher in the perforated group (p=0.017). The most common location of the appendix was retrocecal in the perforated group (p=0.007). While there was no difference in the appendix end diameter, root diameter was significantly higher in the perforated group (p=0.041), as were wall thickness (p<0.001) and appendix length (p=0.037).
CONCLUSION: BMI, prehospital delay, a retrocecally positioned appendix, presence of an abscess, and appendix wall thickness, root diameter, and length are risk factors for perforation in AA.

Apendiksin fiziksel özellklerinin perforasyon üzerine etkileri: Ýleriye yönelik klinik çalýþma

AMAÇ: Akut apandisit (AA) en yaygýn görülen cerrahi acillerden birisidir ve apendiks perfore olduðunda ameliyat sonrasý morbidite ve mortalite artar. Apendiks perforasyonuna yol açan faktörlerin belirlenmesi morbiditeyi azaltmada etkili olabilir. Biz akut apandisitte perforasyonla iliþkili faktörleri inceledik.
GEREÇ VE YÖNTEM: Bu çalýþmada 60 hasta ele alýndý ve hastalar eþit sayýda iki gruba ayrýldý: Non-perfore ve perfore grup. Biz, ameliyat öncesi dönemde hastalarýn vücut kitle indeksini (VKÝ) ve baþvuru öncesi gecikme zamanýný, ameliyat esnasýnda apendiks pozisyonunu, apse veya sývý varlýðý ile cerrahi spesmende apendiksin duvar kalýnlýðýný, kök ve uç çapý ile uzunluðunu karþýlaþtýrdýk.
BULGULAR: Hastalarýn 40’ý erkek, 20’si kadýn olup ortanca yaþ 27 idi (min-maks: 16–84). Vücut kitle indeksi perfore grupta non-perfore gruptan belirgin þekilde yüksekti (p=0.039). Sývý varlýðý açýsýndan gruplar arasýnda fark yok iken, apse varlýðý perfore grupta daha yüksekti (p=0.017). Perfore grupta, apendiksin en yaygýn görüldüðü pozisyon retroçekaldi (p=0.007). Apendiks uç çapýna göre gruplar arasýnda fark yokken, kök çapý, duvar kalýnlýðý ve apendiks uzunluðu perfore grupta belirgin olarak daha yüksekti (sýrasýyla p=0.041, p<0.001 ve p=0.037).
TARTIÞMA: Vücut kitle indeksi, baþvuru öncesi gecikme zamaný, retroçekal yerleþimli apendiks, apse varlýðý ile duvar kalýnlýðý, kök çapý ve apendiks uzunluðu akut apandisitte perforasyonu etkileyen risk faktörleridir.