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The aim of this study was to identify clinical parameters that may help distinguish periappendicitis from the more common clinical entity of acute appendicitis. Serosal inflammation of the appendix without mucosal involvement constitutes the condition known as periappendicitis. In most situations this is a sequel of extra-appendicular sepsis and is likely to benefit from treatment targeted to the underlying pathology. But the majority of these cases are initially treated for acute appendicitis as clinical distinction between the two conditions is difficult. In this study some commonly used clinical yardsticks have been analyzed with respect to their value in this subtle diagnosis. We reviewed 231 successive cases clinically diagnosed as acute appendicitis; of these 18 had histologically demonstrated periappendicitis. Eight parameters were studied: age, gender, temperature, white blood cell count, location and duration of pain, associated symptoms, and peritoneal signs. Significant statistical differences were found between the two groups with regard to pain location, pain duration, and the presence of peritoneal signs. It maybe possible to suspect periappendicitis preoperatively with meticulous clinical assessment. This may be of value in avoiding missed nonappendicular pathologies.
THE TERM "periappendicitis" implies inflammation of the appendicular serosa with preservation of normal mucosal histology. Although this is not an uncommon pathological finding it has only received sporadic mention in the medical literature. Most of these studies have reported a preponderance of females and association with genital infection and concurrent intraabdominal pathology. Such findings suggest that appendectomy does not constitute optimal treatment for this condition. In the current study we have attempted to analyze its clinical features that may help suspect this condition preoperatively and possibly prompt the clinician to consider alternative therapeutic approaches such as laparoscopy.
Materials and Methods
The pathology reports of all consecutive appendix specimens received in the histology department of a 476-bed acute-care facility from January 1, 1997 through December 31, 1998 were investigated. Cases in which the appendectomy was incidental, the charts were deficient in data, or the appendix was histologically normal were deleted from the study. We included only those cases in which the appendix was pathological and was removed with the preoperative diagnosis of acute appendicitis. Of a total of 231 patients 18 had periappendicitis and 213 showed evidence of acute appendicitis (Table 1). We...