Acute appendicitis. A 5-year review.

A startling 31 per cent rate of perforated appendicitis in 1984 prompted a 5-year review at the Guthrie Medical Center. An increase over previous rates of 13 per cent and 0 per cent in 1964 and 1944 was confirmed in this study. Perforation accompanied 44 of 240 cases of appendicitis (18.3%); diagnostic accuracy in 295 cases undergoing operation was 81.4 per cent. Groups at risk for perforation were patients in the first decade of life (34.3% with perforations) and those over 50 years of age (48% perforated). Perforation rates were generally inversely related to accuracy. Accuracy was poorest in women in the second to fourth decade or those in the mid-portion of the menstrual cycle. When the appendix was not perforated, complications occurred in 8.7 per cent of patients while 29.5 per cent with a perforation had a complication. The mean hospital stay was prolonged by 2.5 days if the appendix was perforated. An increased awareness of the risk by both the public and physicians is essential to reduce the number of perforations.