Evaluation of Outcome of a Rare Presentation of Appendicitis

Introduction: Acute appendicitis is the inflammation of the vermiform appendix and it is the most
common intra-abdominal surgical emergency. Therefore, perforated appendicitis is rarely
accompanied by pneumoperitoneum and that apparent rarity of association of pneumoperitoneum and
acute appendicitis prompted us to discuss this condition.
Materials and Methods: This retrospective study reviewed all cases of acute abdomen with
pneumoperitoneum admitted in King Abdulaziz University Hospital from January 2011 to December
2015. Only cases with acute appendicitis were selected to be in the study, Leucocytic count and Creactive
protein, as well as plain X-ray abdomen in erect position and C.T.scan were reviewed
preoperatively.
All demographic data (age, gender), as well as the clinical details which included relevant
investigations results, in addition to the perioperative data (the type of the performed operative
procedure, operative time and the hospital stay with reference to the postoperative complications for
each patient), all were collected and analyzed by IBM-SPSS version 22.
Results: Pneumoperitoneum due to perforated appendix was found in 7 out of 131 cases in this study
(5.3%), with male predominance 6/7, with a mean age of 29.7 years. The documented postoperative
complications were pulmonary complications; intra-abdominal pus collection (pelvic and subphrenic)
as well as wound dehiscence, all were found post conventional exploratory laparotomy cases.
Conclusion: The study documented the rarity of pneumoperitoneum due to perforated appendix.
Therefore, it should be considered as a cause of acute abdomen with pneumoperitoneum, imaging
studies were very essential to visualize these cases, Laparoscopic approach provided better outcome
than the conventional laparotomy approach.