A review of appendectomy cases at a single teaching hospital, Baghdad, Iraq

Mohanad Hamed Abdullah, Mahmood J. Saood, Naser R. Tawfiq


Background: Appendectomy is one of the most commonly performed operations. Accurate preoperative diagnosis has long been a great challenge, even to experienced surgeons. To determine the pattern of presentation and rate of atypical pathological presentation of appendicitis.

Methods: This is a cross-sectional study in which patients who underwent appendectomy for presumed acute appendicitis from June 2012 to June 2016 were recruited. Incidental appendectomy was excluded. Patient demographics, pathological findings, and surgical outcomes were collected.

Results: It was found that the median age of the patients with acute appendicitis was 29 (male 27.3, female 30.7; range (4-67) years. The median length of hospital stay was 2 (range, 1-22) days. There were 184 (75%) patients with clinically and pathologically confirmed acute appendicitis. Out of the 243 patients, 47 appendices were normal, making the overall negative appendectomy rate (NAR) 19.3%; 14.0% in males and 24.6% in females (P<0.001).

Conclusions: Appendectomy continues to be a very common surgical procedure. We suggest a more liberal utilisation of preoperative imaging in females of reproductive age, and patients at the extreme age.


Appendicectomy, Atypical, Pathological, Pattern

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Penfold RB, Chisolm DJ, Nwomeh BC, Kelleher KJ. Geographic disparities in the risk of perforated appendicitis among children in Ohio: 2001-2003. Int J Health Geogr. 2008;7:56-65.

Newman K, Ponsky T, Kittle K, Dyk L, Throop C, Gieseker K, et al. Appendicitis 2000: variability in practice, outcomes, and resource utilization at thirty pediatric hospitals. J Pediatr Surg. 2003;38:372-9.

Bickell NA, Aufses AH, Rojas M, Bodian C. How time affects the risk of rupture in appendicitis. J Am Coll Surg. 2006.203:401-6.

Wullstein C, Barkhausen S, Gross E. Results of laparoscopic vs. conventional appendectomy in complicated appendicitis. Dis Colon Rectum. 2001;44:1700-5.

Papaziogas B, Tsiaousis P, Koutelidakis I, Giakoustidis A, Atmatzidis S, Atmatzidis K. Effect of time on risk of perforation in acute appendicitis. Acta Chir Belg. 2009;109:75-80.

Kearney D, Cahill RA, OBrien E, Kirwan WO, Redmond HP. Influence of delays on perforation risk in adults with acute appendicitis. Dis Colon Rectum. 2008;51:1823-7.

Carvalho BR, Diogo-Filho A, Fernandes C, Barra CB. Leukogram, C-reactive protein, alpha-1 acid glycoprotein and erythrocyte sedimentation rate in acute appendicitis. Arq Gastroenterol. 2003;40:25-30.

Costa JIF, Coelho Filho JM, Lima JMC, Mota RMS, Sousa Filho VJ. Value of abdominal ultrasound with a 5 to 10 mhz multifrequency transducer in the diagnosis of appendicitis. Radiol Bras. 2002;35:85-8.

Vital PF, Martins JL. Current status of diagnosis and treatment of acute appendicitis in children: evaluation of 300 cases. Rev Col Bras Cir. 2005;32:310-5.

Zorzetto AA, Urban LABD, Liu CB, Cruz OR, Vitola MLM, Awamura Y, et al. O uso da ultra-sonografia no diagnóstico e evolução da apendicite aguda. Radiol Bras. 2003;36:71-5.

Gomes CA, Nunes TA. Laparoscopic classification of acute appendicitis: correlation between degrees of disease and perioperative variables. Rev Col Bras Cir. 2006;33:289-93.

Silva SM, Almeida SB, Lima OAT, Guimarães GMN, Silva ACC, Soares AF. Risk factors for complications after appendectomies in adults. Rev Bras Colo-Proctol. 2007;27:31-6.

Brenner AS, Santin J, Virmond Neto F, Boursheid T, Valarini R, Rydygier R. Appendectomy in patients older than 40 years: analysis of the results of 217 cases. Rev Bras Colo-Proctol. 2006;26:128-32.

Almeida MWR, João AT, Oliveira FS, Mattos HC, Silva AR, Silva MGB. Influence of age on length of hospital stay and the degree of evolution of acute appendicitis. Rev Col Bras Cir. 2006;33:294-7.

Lima GJS, Silva AL, Castro EG, Abras GM, Pires LJS, Leite RFG. Effectiveness and safety of video-assisted appendectomy in single transumbilical portal in adolescents and adults. Rev Col Bras Cir. 2008;35:244-51.

Fischer CA, Pinho MSL, Ferreira S, Milani CAC, van Santen CR, Marquardt RA. Acute appendicitis: is there a relation between the evolutionary grade, age and length of hospital stay? Rev Col Bras Cir. 2005;32:136-8.

Kpolugbo J, Njoku T, Osime U. A study of negative appendectomy. Sahel Med J 2003;6:72-4.

Seetahal, Shiva A. Negative appendectomy: a 10-year review of a nationally representative sample. Am J Surg. 2011;4:433-7.

Humes DJ, Simpson J. Acute appendicitis. BMJ. 2006;333:530-4.

Paulson EK, Kalady MF, Pappas TN. Clinical practice. Suspected appendicitis. N Engl J Med. 2003;348:236-42.

Wagner PL, Eachempati SR, Soe K, Pieracci FM, Shou J, Barie PS. Defining the current negative appendectomy rate for whom is preoperative computed tomography making an impact? Surg. 2008;144(2):82-6.

SCOAP Collaborative, Cuschieri J, Florence M, Flum DR. Negative appendectomy and imaging accuracy in the Washington State Surgical Care and Outcomes Assessment Program. Ann Surg. 2008;248:55-63.

Lee SL, Walsh AJ, Ho HS. Computed tomography and ultrasonography do not improve and may delay the diagnosis and treatment of acute appendicitis. Arch Surg. 2001;136:556-62.

Blomqvist PG, Andersson RE, Granath F, Lambe MP, Ekbom AR. Mortality after appendectomy in Sweden, 1985-1996. Ann Surg. 2001;233:455-60.

Stollman N, Raskin JB. Diverticular disease of the colon. Lancet. 2004;363(9409):631-9.

Zulfikar I, Khanzada TW, Sushel C, Samad A. Review of the pathologic diagnoses of appendectomy specimens. Ann King Edward Med Univ. 2009;15(4):168.

Tucker ON, Healy V, Jeffers M, Keane FB. Granulomatous appendicit. Surg. 2003;1:286-9.

Turaga KK, Pappas SG, Gamblin TC. Importance of histologic subtype in the staging of appendiceal tumors. Ann Surg Oncol. 2012;19(5):1379-85.

Bamboat ZM, Berger DL. Is right hemicolectomy for 2cmappendiceal carcinoids justified? Arch Surg. 2006;141:349-52.

Modlin IM, Lye KD, Kidd M. A 5-decade analysis of 13,715carcinoid tumors. Cancer. 2003;97:934-59.

Sugarbaker PH. New standard of care for appendiceal epithelial neoplasms and pseudomyxoma peritonei syndrome? Lancet Oncol. 2006;7(1):69-76.