Weed Iqbal Qureshi, Khalid M Durrani.
Surgical Audit of Acute Appendicitis.
Proceeding Shaikh Zayed Postgrad Med Inst Jan ;14(1):7-12.
Acute appendicitis is one of the most common surgical emergency. Its accurate diagnosis is still not possible especially in young females. A surgical audit of 80 emergency admissions with a diagnosis of acute appendicitis was carried out to find. 1. Accuracy of the diagnosis. 2. To highlight and improve deficiencies in the patient management by critical evaluation of the patient files. 3. Find out other common causes of pain, which can lead to operation. This is a retrospective study with evaluation of the medical file content of patients undergoing appendectomy from October 1998 to September 1999. The results showed that the diagnosis of acute appendicitis is clinical with tenderness and rebound tenderness as the most important physical signs. There was a male dominance of 56%. The average duration of pain was 27 hours. Nausea was present in 53% of the patient, vomiting in 40%. On the basis of histology the appendices were inflamed in 90% and normal in 10%. Seven out of eight patients with normal appendices were young female with a mean age of 21 years. The main postoperative complication was wound infection in 7.5%, mean postoperative stay was 2.85 days. Review of the patient files revealed, in majority of the patients; a failure to record urinary complaints, menstrual history, performance of rectal examination, documentation of the position of appendix and presence of omentum or fuid in right iliac fossa. In some of the patients histological reports were missing when the files were reviewed. Postoperative antibiotics were also used in acute appendicitis. A performa has been designed to improve collection of clinical and histological data for the future in patients with acute appendicitis. The use of antibiotics in acute appendicitis is limited to a single dose of i/v metronidazole preoperatively while its use in the postoperative period for acute appendicitis has been discontinued.
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