Patient Safety in Delayed Diagnosis of Acute Appendicitis
Aly Saber, Mohammad A. Gad, Goda M. Ellabban
DOI: 10.4236/ss.2011.26067   PDF    HTML     6,235 Downloads   11,088 Views   Citations


Introduction: Acute appendicitis is the major surgical abdominal disease in emergency departments and is also among the five leading causes of litigation against emergency physicians. Delayed diagnosis of appendicitis is more likely to occur in patients, who present atypically, and those lack a thorough physical examination, or those received intramuscular narcotic analgesia. 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 complications. Patients & Methods: Patients with complicated appendicitis were subjected to the present study and treated by a single surgical team. The parameters of our study were incidence of perforation or gangrene at surgery, length of stay and post-operative complications. Results: The present study showed that delay in diagnosis of acute appendicitis is associated with a more advanced stage of disease and a higher morbidity. Conclusion: 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.

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A. Saber, M. Gad and G. Ellabban, "Patient Safety in Delayed Diagnosis of Acute Appendicitis," Surgical Science, Vol. 2 No. 6, 2011, pp. 318-321. doi: 10.4236/ss.2011.26067.

Conflicts of Interest

The authors declare no conflicts of interest.


[1] C. Clyde, T. Bax, A. Merg, M. MacFarlane, P. Lin, S. Beyersdorf and M. S. McNevin, “Timing of Intervention does Not Affect Outcome in Acute Appendicitis in a Large Community Practice,” The American Journal of Surgery, Vol. 195, No. 5, 2008, pp. 590-593.
[2] S. Bird, “Failure to Diagnose: Appendicitis,” Australian Family Physician, Vol. 33, No. 12, 2004, pp. 1025-1026.
[3] E. K. Paulson, M. F. Kalady and T. N. Pappas, “Suspected Appendicitis,” The New England Journal of Medicine, Vol. 348, No. 3, 2003, pp. 236-242. doi:10.1056/NEJMcp013351
[4] C. C. Liu, C. L. Lu, D. H. Yen, C. H. Chern, L. M. Wang and C. H. Lee, “Diagnosis of Appendicitis in the ED: Comparison of Surgical and Nonsurgical Residents” American Journal of Emergency Medicine, Vol. 19, No. 2, 2001, pp. 109-112. doi:10.1053/ajem.2001.20006
[5] R. A. Rusnak, J. M. Borer and J. S. Fastow, “Misdiagnosis of Acute Appendicitis: Common Features Discovered in Cases after Litigation,” American Journal of Emergency Medicine, Vol. 12, No. 4, 1994, pp. 397-402. doi:10.1016/0735-6757(94)90047-7
[6] F. K. Althoubaity, “Suspected Acute Appendicitis in female patients. Trends in Diagnosis in Emergency Department in a University Hospital in Western Region of Saudi Arabia,” Saudi Medical Journal, Vol. 27, No. 11, 2006, pp. 1667-1673.
[7] M. F. Ditillo, J. D. Dziura and R. Rabinovici, “Is It Safe to Delay Appendectomy in Adults with Acute Appendicitis?” Annals of Surgery, 2006, Vol. 244, No. 5, pp. 656-660. doi:10.1097/01.sla.0000231726.53487.dd
[8] L. Graff, J. Russell, J. Seashore, et al., “False-Negative and False-Positive Errors in Abdominal Pain Evaluation: Failure to Diagnose Acute Appendicitis and Unnecessary Surgery,” Academic Emergency Medicine, Vol. 7, No. 11, 2000, pp. 1244-1255. doi:10.1111/j.1553-2712.2000.tb00470.x
[9] M. Kraemer, C. Franke, C. Ohmann, Q. Yang and Acute Abdominal Pain Study Group, “Acute Appendicitis in Late Adulthood: Incidence, Presentation, and outcome. Results of a Prospective Multicenter Acute Abdominal Pain Study and a Review of the Literature,” Langenbecks Archives of Surgery, Vol. 385, No. 7, 2000, pp. 470-481. doi:10.1007/s004230000165
[10] V. A. Pittman-Waller, J. G. Myers, R. M. Stewart, D. L. Dent, C. P. Page, G. A. Gray, B. A. Pruitt Jr. and H. D. Root, “Appendicitis: Why So Complicated? Analysis of 5755 Consecutive Appendectomies,” The American surgeon, Vol. 66, No. 6, 2000, pp. 548-554
[11] S. Eldar, E. Nash, E. Sabo, I. Matter, J. Kunin, J. G. Mogilner and J. Abrahamson, “Delay of Surgery in Acute Appendicitis,” The American Journal of Surgery, 1997, Vol. 173, No. 3, pp. 194-198.
[12] A. S. Earley, J. P Pryor, P. K. Kim, J. H. Hedrick, J. E. Kurichi, A. C. Minogue, S. S. Sonnad, P. M. Reilly and C. W. Schwab, “An Acute Care Surgery Model Improves Outcomes in Patients with Appendicitis,” Annals of Surgery, Vol. 244, No. 4, 2006, pp. 498-504.
[13] D. Yardeni, R. B. Hirschl, R. A. Drongowski, D. H. Teitelbaum, J. D. Geiger and A. G. Coran, “Delayed versus Immediate Surgery in Acute Appendicitis: Do We Need to Operate during the Night?” Journal of Pediatric Surgery, Vol. 39, No. 3, 2004, pp. 464-469. doi:10.1016/j.jpedsurg.2003.11.020
[14] C. Brigand, J. P. Steinmetz and S. Rohr, “The Usefulness of Scores in the Diagnosis of Appendicitis,” Journal de Chirurgie, Vol. 146, No. 1, 2009, pp. 2-7. doi:10.1016/j.jchir.2009.08.001
[15] C. J. Schupp, V. Klingmüller, K. Strauch, M. Bahr, D. Zovko, T. Hannmann and S. Loff, “Typical Signs of Acute Appendicitis in Ultrasonography Mimicked by Other Diseases?” Pediatric Surgery International, Vol. 26, No. 7, 2010, pp. 697-702. doi:10.1007/s00383-010-2617-2
[16] O. Monneuse, S. Abdalla, F. Pilleul, V. Hervieu, L. Gruner, E. Tissot and X. Barth, “Pain as the Only Consistent Sign of Acute Appendicitis: Lack of Inflammatory Signs does Not Exclude the Diagnosis,” World Journal of Surgery, Vol. 34, No. 2, 2010, pp. 210-215. doi:10.1007/s00268-009-0349-z
[17] Y. Pouget-Baudry, S. Mucci, E. Eyssartier, A. Guesdon- Portes, P. L ada, C. Casa, J. P. Arnaud and A. Hamy, “The Use of the Alvarado Score in the Management of Right Lower Quadrant Abdominal Pain in the Adult,” Journal of Visceral Surgery, Vol. 147, No. 2, 2010, pp. e40-e44. doi:10.1016/j.jviscsurg.2010.05.002
[18] B. Sanei, M. Mahmoodieh and M. Hosseinpour, “Evaluation of Validity of Alvarado Scoring System for Diagnosis of Acute Appendicitis,” Pakistan Journal of Medical Sciences, Vol. 25, No. 2, 2009, pp. 298-301.
[19] M. Horzi?, A. Salamon, M. Kopljar, M. Skupnjak, K. Cupurdija and D. Vanjak, “Analysis of Scores in Diagnosis of Acute Appendicitis in Women,” Collegium Antropologicum, Vol. 29, No. 1, 2005, pp. 133-138.
[20] A. Mohamed and N. Bhat, “Acute Appendicitis Dilemma of Diagnosis and Management,” Internet Journal of Surgery, Vol. 23, No. 2, 2010, pp. 1528-8242.
[21] C. H. Chung, C. P. Ng and K. K. Lai, “Delays by Patients, Emergency Physicians, and Surgeons in the Management of Acute Appendicitis: Retrospective Study,” Hong Kong Medical Journal, Vol. 6, No. 3, 2000, pp. 254-259.

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