A study on site of perforation in acute appendicitis and its effect on post-operative complications.

Abstract

Aim of the Study To determine if the site of perforation of appendix has any effect on post-operative complications. Methodology
Patients with diagnosis of appendicular perforation confirmed intra-operatively were allocated into 3 groups based on the site of perforation (Group A – Tip, Group B – Base, Group C – Body of appendix). The patients where a definite site of perforation could not be found were excluded. Baseline data, Intra-operative complications, prevalence of risk factors and post-operative outcomes were noted.
Results Total of 57 patients were included in the study. Group A had 31 patients, Group B had 20 patients and Group C had 6 patients. The prevalence of risk factors found in this study were, time delay till appendectomy (68.42 %), male gender (68.42 %), presence of faecolith (57.89 %), age over 50 years (43.86 %), diabetes mellitus (33.33 %) and history of previous surgery (36.84 %). 4 out of 20 patients in Group B had iatrogenic bowel injury compared with 2 out of 31 patients of Group A. 3 patients of Group B had a gangrenous base without a residual healthy stump. The patients with perforation at the base had higher length of hospital stay (p- value 0.031) and mean CCI score (p- value 0.036) compared with other groups.
Conclusion Patients with perforation of appendix base had higher incidence of intraoperative and postoperative complications. Knowing the site of perforation may help the surgeon to plan a proper intraoperative and postoperative management protocol