[Acute appendicitis: a study on 118 patients]

One hundred eighteen patients with acute appendicitis operated on at Kawasaki Medical School Hospital during the 8-year period from Aug. 1, 1976 to Feb. 29, 1984 were reviewed. There were 78 children and 40 adults. The clinico-pathological types of acute appendicitis were: simple acute in 35 cases (29.7%); phlegmonous in 30 cases (25.4%); gangrenous in 24 cases (20.3%) and perforated in 29 cases (24.6%). Of the 78 children, 27 (34.6%) had perforated appendixes, whereas of the 40 adults only 2 (5.0%) showed perforated appendicitis. The initial symptoms were abdominal pain in 96.6%; nausea, vomiting or both in 33.1%, and fever in 11.9%. The physical findings on admission were abdominal tenderness in 99.2%, rebound tenderness in 52.5% and palpable mass in 17.8%. The mean body temperature on admission was 37.2 degrees C, and mean WBC count was 12,900/mm3. The roentgenography of the abdomen revealed the "sentinel loop sign" in 66.3%. In the patients under 15 years of age, the frequency of perforation seen in those underwent operation within 24 hours after onset and in those after 24 hours was 12.7% and 56.4%, respectively. From this result, it is advised that all the young patients suspected of having acute appendicitis should be admitted to the hospital promptly, and the diagnosis should be made within 24 hours.