Related Experiment Videos
[Questionable appendectomies]
Y Flamant1, O L Zantain, J Barge
1Service de chirurgie générale, hôpital Louis-Mourier, Colombes.
Abstract:
Each year in France, 75,000 appendectomies are carried out for normal or fibrous appendix and another 75,000 for a mere inflammation of the mucosa of submucosa. To decrease the incidence--four times higher than in other countries--it is suggested to keep under observation the patient with RIQ tenderness if they have neither rebound nor guarding, a temperature below or equal to 38 degrees C and a white blood cell count lower than 10,000/mm3. By following these guidelines, there is no risk to miss perforated or suppurated appendicitis.
Insights
To reduce high appendectomy rates in France, observe patients with right lower quadrant tenderness if they lack rebound tenderness, guarding, have a temperature ≤38°C, and white blood cell count <10,000/mm3. This approach safely identifies appendicitis without missing perforated cases.
Area of Science:
- General Surgery
- Clinical Medicine
Context:
- France performs 150,000 appendectomies annually, with an incidence four times higher than other countries.
- A significant number of these procedures are for non-perforated or minimally inflamed appendix cases.
Purpose:
- To propose a clinical guideline to decrease the high rate of appendectomies in France.
- To identify patients with right lower quadrant (RIQ) tenderness who can be safely managed non-operatively.
Summary:
- The guideline suggests observing patients with RIQ tenderness if they present without rebound tenderness or guarding.
- Key indicators for observation include a temperature ≤38°C and a white blood cell count below 10,000/mm3.
- Adherence to these criteria ensures that perforated or suppurated appendicitis is not missed.
Impact:
- Potential to significantly reduce the number of unnecessary appendectomies in France.
- Aims to improve resource allocation in surgical departments.
- Provides a safe and effective strategy for managing suspected appendicitis cases.