Chronic Appendicitis
Characteristic
the pain lasts longer and is
less intense than that of
acute appendicitis but is in
the same location
anorexia and occasionally
There is a much lower nausea, pain with motion,
incidence of vomiting, and malaise are
characteristic
 Supporting Examination

Leukocyte counts are CT scans are generally

predictably normal nondiagnostic
 Management

At operation, surgeons can Laparoscopy can be used Many of those whose

establish the diagnosis with effectively in the symptoms are not cured or
94% specificity and 78% management of this clinical recur are ultimately diagnosed
sensitivity entity with Crohn’s disease
Incidental Appendicitis
• Decisions regarding the efficacy of incidental appendectomy should
be based on the epidemiology of appendicitis
• The best data were published by the Centers for Disease Control and
Prevention based on the period from 1979 to 1984
• During this period, an average of 250,000 cases of appendicitis
occurred annually in the United States.
• The highest annual incidence of appendicitis was in patients 9 to 19
years of age (23.3 per 10,000 population). Males were more likely to
develop appendicitis than females. Accordingly, the incidence during
teenage years was 27.6 in males and 20.5 in females per 10,000
population per year.
• Annual incidence was 6 in 10,000 males and 4 in 10,000 females.
• When the life table technique was used, the data identified a lifetime
risk of appendicitis of 8.6% in men and 6.7% in women.
• Although men were more likely to develop appendicitis, the
preoperative diagnosis was correct in 91.2% of men and 78.6% of
women.
• Similarly, perforation occurred more commonly in men than in
women (19.2 vs. 17.8%).
• In contrast to the number of cases of appendicitis, 310,000 incidental
appendectomies were performed between 1979 and 1984, 62% of
the total appendectomies in men and 17.7% of those in women.
• Based on these data, 36 incidental appendectomies had to be
performed to prevent one patient from developing appendicitis.
• The financial aspects of the decision to perform incidental
appendectomy were assessed.
• For open appendectomy, there was a financial disincentive to perform
incidental appendectomy, on an annual basis, $20,000,000 had to be
spent to save the $6,000,000 cost of appendicitis.
• With the laparoscopic approach, it was cost effective to perform
incidental appendectomy only in patients <25 years of age and only if
the reimbursement for surgeons was 10% of the usual and customary
charges.
• At a higher rate of reimbursement, incidental appendectomy was not
cost effective in any age group.
• Although incidental appendectomy is generally neither clinically nor
economically appropriate, there are some special patient groups in
whom it should be performed during laparotomy or laparoscopy for
other indications.
Prognosis
• The mortality from appendicitis in the United States has steadily
decreased from a rate of 9.9 per 100,000 in 1939 to 0.2 per 100,000
• Among the factors responsible are advances in anesthesia, antibiotics,
IV fluids, and blood products.
• Principal factors influencing mortality are whether rupture occurs
before surgical treatment and the age of the patient.
• The overall mortality rate in acute appendicitis with rupture is
approximately 1%.
• The mortality rate of appendicitis with rupture in the elderly is
approximately 5%.
• Death is usually attributable to uncontrolled sepsis—peritonitis, intra-
abdominal abscesses, or gram-negative septicemia
• In one report, complications occurred in 3% of patients with
nonperforated appendicitis and in 47% of patients with perforations.