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Appendicitis: a continuing challenge
Insights
This study on acute appendicitis found that routine investigations and peritoneal fluid cultures offered little benefit. Antibiotic treatment duration for simple appendicitis could be shortened, and ampicillin resistance is a concern.
Area of Science:
- Surgery
- Infectious Diseases
- Clinical Diagnostics
Background:
- Acute appendicitis is a frequent surgical emergency, particularly in developing urban areas.
- Current diagnostic and treatment protocols for acute appendicitis involve clinical judgment, investigations, and antibiotic therapy.
Purpose of the Study:
- To analyze current practices in diagnosing and managing acute appendicitis.
- To identify areas for improvement in diagnostic accuracy and treatment efficacy.
Main Methods:
- Retrospective review of 103 adult patients with histologically proven acute appendicitis at Aga Khan University Hospital.
- Analysis of diagnostic investigations (leukocyte count, ultrasound) and treatment outcomes (antibiotic duration, culture studies).
Main Results:
- Clinical diagnosis was sufficient; investigations like leukocyte count and ultrasound showed no clear diagnostic advantage.
- Routine investigations (hemoglobin, electrolytes) provided no additional information.
- Peritoneal fluid cultures had low yield (26%) and did not impact management of simple appendicitis.
- High resistance (73%) to ampicillin was observed in bacterial peritonitis.
- Antibiotic treatment duration for acute simple appendicitis could potentially be reduced to a single preoperative dose.
Conclusions:
- Diagnostic investigations beyond clinical assessment may not significantly improve accuracy for acute appendicitis.
- Current antibiotic regimens, including ampicillin use and treatment duration, require re-evaluation due to resistance and potential for shorter treatment courses.
- Further studies are needed to define optimal antibiotic strategies for acute simple appendicitis.
Abstract:
Acute appendicitis is a common surgical emergency in urban setting, of a developing country. The computerised hospital patient database at Aga Khan University Hospital, Karachi, was utilised to obtain records of all adults with a histologically proven diagnosis of acute appendicitis. A review of patients treated over a 18 month period was undertaken. One hundred and three appendicectomies were performed for acute appendicitis during this period. The diagnosis was clinical in all cases. Investigations like leucocyte count and lower abdominal ultrasound scan were used to improve diagnostic accuracy without a clear advantage. A number of routine investigations like, haemoglobin estimation and urea, creatinine, electrolyte measurements, did not provide additional information. The duration of antibiotic treatment in acute simple appendicitis was empiric and could be reduced to a single preoperative dose. Peritoneal fluid culture studies had a poor yield (26%) and results were not found to effect management in acute simple appendicitis. The routine use of Ampicillin in all cases of bacterial peritonitis needs re-evaluation, as a high incidence (73%) of resistance was seen. Studies to define the role and duration of treatment, with a single antibiotic, in acute simple appendicitis should be undertaken. Acute appendicitis is probably the most frequently considered surgical differential diagnosis at any hospital dealing with acute surgical conditions. The established treatment continues to be surgical removal of the inflamed organ. The diagnosis and decision to operate both are accepted to be based on clinical judgement, though a number of investigative manoeuvres have been described to reduce the negative appendicectomy rate. Other areas of debate are the number and length of antibiotic treatment and use of bacterial culture studies in cases of simple acute appendicitis. To analyse present practice and identify areas for study and change, a retrospective study was undertaken at Aga Khan University Hospital (AKUH), Karachi.