Authors

Trauma Research Center, Surgery Department, Shiraz University of Medical Sciences

Abstract

Objective: To evaluate the accuracy of surgeons’ intraoperative diagnosis in open appendectomy and compare it with the histopathology examination results afterwards.Methods: This was a cross-sectional retrospective study accomplished in Namazee hospital affiliated with Shiraz University of Medical Sciences, in a one-year period from 2007 to 2008. Medical charts of all the patients who were admitted with impression of acute appendicitis and underwent open appendectomy in our center were included. Demographic information, intraoperative findings as in the operation note based on a method used by our  surgeons, and histopathology examination  of the removed appendix were recorded and reported.Results: A total of 342 patients were studied including 229 (67%) males and 113 (33%) females, with the mean age of 16.02 ± 9.89 (range 3 to 76) years, with a large proportion from 10 to 15 years. Surgeons reported 97.4% of the patients to have acute appendicitis,29.5%, 10.2% and  5.6% with severe, moderate  and  mild inflammation  pectively, whereas 26.6%  and 9.4% with suppurated  and gangrenous  appendicitis  separately, 14.6% to  have perforated appendicitis and only 1.5%hadperforated appendicitis with peritonitis. However, 79.5% of cases showed appendicitis in the histopathology review. The accuracy of surgeons’ intraoperative diagnosis is 81.6%, 85.2% for men and 72.6% for women.Conclusion: The method used by our surgeon is not completely indicative in mild to severe inflamed appendix but it is almost always compatible with the pathology results in suppurated, gangrened, and perforated appendix. Therefore surgeons’ gross observation of the  inflamed appendix  may not  always be in  concordance  with the  histopathology examination of the resected appendix.

Keywords

  1. Samelson SL, Reyes HM. Management of perforated appendicitis in children--revisited. Arch Surg 1987;122(6):691-6.
  2. Paydar S, Shokrollahi S, Jahanabadi S, Ghaffarpasand F, Malekmohammadi Z, Akbarzadeh A, et al. Emergency Operating Room Workload Pattern: A Single Center Experience from Southern Iran. Bull Emerg Trauma 2013;1(1):38-42.
  3. A sound approach to the diagnosis of acute appendicitis. Lancet 1987;1(8526):198-200.
  4. Malik AA, Bari SU. Conservative management of acute appendicitis. J Gastrointest Surg 2009;13(5):966-70.
  5. Schwartz SI, Brunicardi FC. Schwartz's principles of surgery. 9th ed. New York:McGraw- Hill, Medical Pub, Division, 2010; p.1075.
  6. Paydar S, Akbarzadeh A, Manafi AR, Ghaffarpasand F. Short-term outcome of open appendectomy in southern Iran: a single center experience. Bull Emerg Trauma 2013;1(3):123-6.
  7. Addiss DG, Shaffer N, Fowler BS, Tauxe RV. The epidemiology of appendicitis and appendectomy in the United States. Am J Epidemiol 1990;132(5):910-25.
  8. Yilmaz M, Akbulut S, Kutluturk K, Sahin N, Arabaci E, Ara C, et al. Unusual histopathological findings in appendectomyspecimens from patients with suspected acute appendicitis. World J Gastroenterol 2013;19(25):4015-22.
  9. Memon ZA,Irfan S,Fatima K,Iqbal MS, Sami W. Acute appendicitis: diagnostic accuracy of Alvarado scoring system. Asian J Surg 2013;36(4):144-9.
  10. Riber C, Tønnesen H, Aru A, Bjerregaard B. Observer variation in the assessment of the histopathologicdiagnosis of acute appendicitis. Scand J Gastroenterol 1999;34(1):46-9.
  11. Marudanayagam R, Williams GT, Rees BI. Review of the pathological results of 2660 appendicectomy specimens. J Gastroenterol 2006;41(8):745-9.
  12. Flum DR, Koepsell T. The clinical and economic correlates of misdiagnosed appendicitis: nationwide analysis. Arch Surg 2002;137(7):799-804; discussion 804.
  13. Flum DR, Morris A, Koepsell T, Dellinger EP. Has misdiagnosis of appendicitis decreased over time? A population-based analysis. JAMA 2001;286(14):1748-53.
  14. Colson M, Skinner KA, Dunnington G. High negative appendectomy rates are no longer acceptable. Am J Surg 1997;174(6):723-6; discussion 726-7.
  15. Ponsky TA, Hafi M, Heiss K, Dinsmore J, Newman KD, Gilbert J. Interobserver variation in the assessment of appendiceal perforation. J Laparoendosc Adv Surg Tech A 2009;19 Suppl 1:S15-8.
  16. Monajemzadeh M, Hagghi-Ashtiani MT, Montaser-Kouhsari L, Ahmadi H, Zargoosh H, Kalantari M. Pathologic evaluation of appendectomy specimens in children: is routine histopatholgic examination indicated? Iran J Pediatr 2011;21(4):485-90.
  17. Khan I, ur Rehman A. Application of Alvarado scoring system indiagnosis of acute appendicitis. J Ayub Med Coll Abbottabad 2005;17(3):41-4.
  18. Chan MYP, Tan C, Chiu MT, Ng YY. Alvarado score: an admission criterion in patients with right iliac fossa pain. The Surgeon 2003;1(1):39-41.
  19. Limpawattanasiri C. Alvarado score for the acute appendicitisin a provincial hospital. J Med Assoc Thai 2011;94(4):441-9.
  20. Bongard F, Landers DV, Lewis F. Differential diagnosis of appendicitis and pelvic inflammatory disease. A prospective analysis. Am J Surg 1985;150(1):90-6.
  21. Knight PJ, Vassy LE. Specific diseases mimicking appendicitis in childhood. Arch Surg 1981;116(6):744-6.
  22. McDonald JC. Nonspecific mesenteric lymphadenitis. Surg Gynecol Obstet 1963;116:409.