Jurnal reading

Patient Safety in Delayed Diagnosis of Acute Appendicitis

OLEH:
Aditya Azwar S
15 71 0362

PEMBIMBING:
dr. Saiful Burhan Sp.B
Definition appendicitis acute
Acute appendicitis is inflamation of the appendix, the
narrow, finger shaped organ that branches of the first of the
large intestine on the right side of the abdomen
 Acute Appendicitis (AA) is the most commonly encountered
disease in emergency clinics,with about 250,000 cases of
appendicitis reported in The United States and 40,000 in
England each year.
 Acute appendicitis is seen more commonly in young people
aged 10-19 and in males
 a male to female ratio of 4:1, the overall lifetime risk is 8,6%
for males and 6,7% for females in the United States
Causes of acute appendicitis
 In many cases, the cause for appendicitis is unknown.
There can also be multiple causes for one case of
appendicitis.; luminal obtruction,dietary and familial
factors
Patofisiologi

Apendisitis Apendisitis
Apendisitis akut
supuratif Gangrenosa
fokal (peradangan
(pembentukan (kematian jaringan
lokal)
nanah) apendiks)

Peritonitis
Perforasi
(peradangan
(bocornya dinding
lapisan rongga
apendiks )
perut)
Terjadi obstruksi  mucus yg diproduksi mukosa mengalami
bendungan  makin lama mucus makin banyak, tp elastisitas
dinding apendiks mempunyai keterbatasan  pe↑ tek.
intralumen  menghambat aliran limfe  terjadi edema,
diapedesis bakteri, & ulserasi mukosa  ditandai oleh nyeri
epigatrium (Apendisitis Akut Fokal)

Bila sekresi mucus terus berlanjut  tekanan jd terus me↑↑ 

obstruksi limfe,vena,arteri , & bakteri akan menembus dinding
 peradangan meluas & mengenai peritoneum setempat  shg
timbul nyeri di daerah kanan bawah (Apendisitis Supuratif
Akut)

Bila aliran arteri terganggu  infark dinding apendiks yg diikuti

dgn gangrene. (Apendisitis Gangrenosa)

Bila dinding yang telah rapuh itu pecah  (Apendisitis

Perforasi)

Nanah keluar menetes  Peritonisis lokal  Semakin banyak nanah yang melokalisir bagian
peritonium  (Peritonitis umum)
introduction
 Acute appendicitis is the major surgical abdominal dis-
ease in emergency departments and it is also among the
five leading causes of litigation against emergency
physicians.
 Delayed diagnosis of appen-dicitis is more likely to occur
in patients, who present atypically, and those lack a
thorough physical exami-nation, or those received
intramuscular narcotic analgesia.
Aim of the Work
 The aim of this study was to study the effect of delay in
diagnosis of acute appendicitis as regard postoperative
findings, length of hospital stay and post-operative com-
plications.
Patients & Methods
 Study site and time
 Information collected from database in Port Fouad general
hospital between January 1, 2006 and March 1, 2008.
 Patient
 All patients, male and females at any age
 padmitted during that period for surgery for complicated
appedecectomy were subjected to the present study and treated by a
single surgical team
 Collected Data
 Data were collected from the registration and statistics unit in
Port Fouad general hospital

 Parameters of evaluation:
1) Incidence of perforation or gangrene at surgery,
2) Length of stay (LOS), and
3) post-operative complications.

 The operative finding was graded as four-grade system

Grade 1 : acute appendicitis
Grade 2 : gangrenous acute appendicitis
Grade 3 : perfo-ration
Grade 4 : periappendicular abscess
Result
The overall number of appedecectomies done within the period
of study was 112 by the same single surgical team.
The total number of complicated appedecectomy was 22
patients, 16 males and 6 females.
 result
A. The pattern of delayed diagnosis was discharge from the
emergency room department in 21 patients and in only one
patient
B. The length of hospital stay was studied in patients treated for
The length of hospital stay was studied in patients treated for

simple non-complicated appendicitis complicated appendicitis

( 90 people) ( 22 people )

C. Postoperative bowel function

non-complicated appendicitis complicated appendicitis ileus
patients
8 - 12 hours 36 - 72 hours
result
D. Septic complications
• were detected in both groups.
• The incidence was greater in complicated than non-
complicated appendicitis patients
• complicated appendicitis patients:
• intra-abdominal sepsis pelvic abscess in 2/22 patients
• deep wound sepsis was seen in 6/22 patients
• Non complicated appendicitis : no intra-abdominal sepsis
discussion
• Acute appendicitis is the second most common cause of
surgical abdominal disease in late adulthood and major errors
in management are made frequently and the condi-tion is
associated with significant morbidity and mortality
• In the present study, we showed that delay in diagnosis of
acute appendicitis was associated with a more advanced stage
of disease and a higher morbidity. Other study stressed on the
pre-admission delay on the part of the patient and the post-
admission delay on the part of the surgeon as how both
shared in causing a more advanced stage of disease and
consequent complications is still debated
• acute appendicitis is among the five leading causes of litigation
against emergency physicians
• Some studies showed that the diagnosis of acute appendicitis
The Al-varado score is a validated test in clinical adult surgery
practice which can be helpful in the diagnosis of acute
appendicitis. Others reported that radiological ex-aminations
are very helpful to determine the diagnosis even when the
patient presents atypically
conclussion
Discusion
• careful attention to the patient’s history; a thorough
physical examination and early clinical review help to
minimize the possibility of delayed diagnosis of
appendicitis.
• Appendicitis with a delay in treatment usually leads to
high perforation rates, and unfavorable outcome.