Clinical Predictors of Perforation in Patients with Acute Appendicitis

Open Access

Abstract

Background: Acute appendicitis is the most common surgical emergency of the abdomen, and perforation significantly contributes to the morbidity, length of stay, and cost of the surgical procedure. The purpose of this study was to determine the clinical, laboratory, and sonographic factors associated with perforation of the appendix in patients with acute appendicitis. Methods & Materials: This cross-sectional analytical study was conducted at the Sir Salimullah Medical College Mitford Hospital, Dhaka, Bangladesh from June 2017 to May 2018, with 60 patients who underwent appendectomy for acute appendicitis. Sociodemographic, clinical, laboratory, and ultrasonographic data were collected and analyzed using SPSS version 26. Results: 60 patients were found, 22 of whom (36.7%) had perforated appendicitis. In bivariate analysis, symptom duration >48 hours, fever ≥38°C, rebound tenderness, guarding/rigidity, leukocytosis >15,000/mm³, neutrophilia >75%, CRP >10 mg/L, and periappendiceal fluid on ultrasonography were significantly associated with perforation (p<0.05). Multivariable analysis revealed that symptom duration >48 hours (AOR 5.82), fever ≥38°C (AOR 3.76), guarding/rigidity (AOR 3.41), and periappendiceal fluid on ultrasonography (AOR 4.52) were independent risk factors for perforation. Conclusions: Delayed presentation, fever, guarding/rigidity, and periappendiceal fluid on ultrasonography are independent predictors of appendiceal perforation and can help guide the clinician to recognize high-risk patients who should be treated promptly with surgery.