Some factors affecting perforation in acute appendicitis

When acute appendicitis progresses to perforation, the consequences often lead to prolonged and difficult convalescence or even to death. It was of interest therefore to study a sample of patients with acute appendicitis and to investigate what factors appear to affect perforation in acute appendicitis. A series is presented of 248 patients with acute appendicitis. Seventy-seven of these were found to have perforated or gangrenous appendix at operation. The results showed that perforation of the appendix is strongly influenced by patient factors, the length of the prehospitalization phase of illness and age. Furthermore, patients with a previous history of episodes of right lower abdominal pain not leading to operation, had a higher frequency of perforation of the appendix. Perforation of the appendix was slightly more frequent among men, and among patients with concomitant chronic or malignant diseases, but the difference was not statistically significant. These findings might help to individualize the approach of the surgeon to the patient with suspected acute appendicitis and influence the clinical strategy.