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Frequency of abdominal surgery in patients with familial Mediterranean fever
Timuçin Kaşifoğlu1, Döndü Usküdar Cansu, Cengiz Korkmaz
1Division of Rheumatology, Deparment of Internal Medicine, Eskisehir Osmangazi University Medical Faculty, Eskişehir, Turkey. tkas@mynet.com
Objective:
Familial Mediterranean fever (FMF) is characterized by recurrent episodes of peritonitis. Abdominal FMF attacks can be indistinguishable from those of an acute abdominal emergency, and patients may undergo one or more laparotomies before the true nature of their disease is documented. The objectives of this study were to investigate the frequency and reasons for abdominal surgeries performed on patients with FMF.
Methods:
We retrospectively reviewed the files of 254 patients with FMF (127 males, 127 females, mean age 27.2+/-6.3 years). We also included 182 healthy individuals for this study (89 males, 93 females, mean age 27.6+/-5 years; range 11-43) to make a comparison between FMF and healthy controls (HC) with respect to frequency of abdominal operations.
Results:
The number of patients with abdominal surgery in FMF group was 74 (29.1%). The number of surgeries performed in 74 patients with FMF was 92. The first abdominal surgery before the diagnosis of FMF was appendectomy in 68 patients (26.6%). In HC group, the number of abdominal operations was found to be 16 (8.7%). Of these abdominal operations, 9 (4.9%) were due to appendectomy. The rate of total abdominal operations and appendectomy were significantly higher in FMF group than in HC group (p=0.0001).
Conclusion:
Abdominal attacks of FMF patients may cause an unnecessary laparotomy prior to the diagnosis of FMF. FMF patients can present with abdominal emergency while they are receiving colchicine. Therefore, each abdominal pain should be carefully determined according to clinical findings. The purpose of this study was to emphasize the misdiagnosis of appendicitis.
Insights
Familial Mediterranean fever (FMF) patients frequently undergo unnecessary abdominal surgeries, often appendectomies, before diagnosis. This highlights the need for careful clinical evaluation to avoid misdiagnosis of appendicitis in FMF patients.
Area of Science:
- Rheumatology
- Gastroenterology
- Surgical Gastroenterology
Background:
- Familial Mediterranean fever (FMF) is a genetic autoinflammatory disorder characterized by recurrent episodes of serositis, primarily peritonitis.
- Abdominal manifestations of FMF can mimic acute abdominal emergencies, leading to diagnostic challenges and potential surgical interventions.
- Misdiagnosis of FMF as acute appendicitis is a common issue, resulting in delayed definitive diagnosis and treatment.
Purpose of the Study:
- To determine the frequency of abdominal surgeries in patients diagnosed with Familial Mediterranean fever (FMF).
- To identify the primary reasons for abdominal surgeries performed on FMF patients, particularly before diagnosis.
- To emphasize the diagnostic challenges posed by FMF and the frequent misdiagnosis of appendicitis.
Main Methods:
- Retrospective review of medical records for 254 FMF patients (127 males, 127 females).
- Inclusion of 182 healthy controls (89 males, 93 females) for comparative analysis of abdominal operation rates.
- Comparison of abdominal surgery frequency, including appendectomy, between FMF patients and healthy controls.
Main Results:
- A significant proportion of FMF patients (29.1%) underwent abdominal surgery, with 74 patients having 92 operations in total.
- Appendectomy was the most common initial surgery before FMF diagnosis, performed in 68 FMF patients (26.6%).
- Abdominal operations and appendectomies were significantly more frequent in the FMF group compared to healthy controls (8.7% and 4.9% respectively, p=0.0001).
Conclusions:
- Recurrent abdominal attacks in FMF patients can lead to unnecessary laparotomies and misdiagnosis, particularly of appendicitis.
- FMF patients may present with acute abdominal symptoms even while undergoing treatment with colchicine, necessitating careful clinical assessment.
- Accurate and timely diagnosis of FMF is crucial to prevent misdiagnosis and subsequent surgical interventions for conditions like appendicitis.
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