RESEARCH – June 2007

Acute appendicitis: incidence and diagnosis in Tartu county


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Background and aims. Acute appendicitis has been continuously the most frequent emergency surgical disease. The basis of its clinical diagnosis is typical anamnesis combined with objective and clinical findings. For assessment of the incidence of acute appendicitis and its diagnosis, a retrospective review of the data of medical records of all patients from the service area of Tartu, treated in 2004, was conducted comparing the data with the corresponding data for 1974.
Material and methods. In 2004, altogether 304 patients, 140 women and 164 men, aged 1 to 92 years, from the service area of Tartu (187,000 population) were diagnosed with acute appendicitis and were treated at the Clinic of Surgery of Tartu University Hospital. Initial clinical and laboratory examinations were evaluated in relation to anamnesis, and intraoperative and pathological findings.
Results. During the last 30 years the incidence of appendicitis in Tartu county has significantly decreased, being 163 per 100,000 person-years, but the incidence of perforated appendicitis, 24 per 100,000 person-years, has not changed. Of the patients 7% were hospitalized up to 6 hours and 50% 7 up to 24 hours after the onset of the disease; 24% were hospitalized with delay, i.e. more than 24 hours after disease onset. The delay was accompanied with an exacerbation of inflammation and an increase in the incidence of perforations from 9% to 22%. In addition to clinical symptoms, the level of C-reactive protein and the diagnostic criterion of ultrasonography correlated significantly with anamnesis and with severity of inflammation. According to postoperative pathological findings, the share of negative appendectomies was 24%.
Conclusion. Although the incidence of acute appendicitis in Tartu county has significantly decreased  during the last 30 years, the proportion of complications has remained the same. Owing to problems with early clinical diagnostics and complications associated with manifestation of acute appendicitis, every fourth removed appendix is free from signs of inflammation and every seventh is perforated. In the case of a typical disease course, the objective finding does not allow the surgeon  to be misled. In the case of an atypical disease course, quantitative determination of the C-reactive protein and ultrasonography could be more helpful. To reduce the complications associated with manifestation of acute appendicitis, the diagnosis should be considered in the case of abdominal pain lasting more than 6 hours.