{"paper_id":"c06d35cb-c2e9-468c-b4dd-86d5088d223a","body_text":"Acute appendicitis and associated pathologies in females                                               AH Kadhem, AA Muhsin & WH Al-Sewadi \nBasrah Journal                                                       Original Article \nOf Surgery                                                         Bas J Surg, June, 26, 2020 \n \nACUTE APPENDICITIS AND ASSOCIATED \nPATHOLOGIES  IN  FEMALES  \n \nAli Hameed Kadhem @, A'amena Abdul-Ameer Muhsin *& Wisam \nHamza Al-Sewadi# \n@MB,ChB, CABS, Consultant General  Surgeon, Alsadr Teaching Hospi tal. *MB,ChB, Arab Board \nCandidate, Alsadr Teaching Hospital, Basrah. #CABS, FACS, FRCS, FICSM RCS, F.MAS, General and \nlaparoscopic Surgeon, Al-Zahraa College of Medicine, University of Basrah, Basrah, IRAQ.  \n \nAbstract  \nIn females with right lower quadrant acute abdominal pain, gyne cological & obstetric \npathologies are the main disorders that should be eliminated from the diagnosis of acute \nappendicitis. This study included pathologic findings in 120 ap pendectomies in Al-Sadr \nTeaching Hospital in which exploration was performed as emergen cy acute appendectomies in \n52 cases, while other pathologic processes related to gynecolog ical diseases are distanced \nfrom appendicitis intraoperatively.  \n There is a high percentage of c oexistence with ovarian cyst in all its types whether twisted, \nruptured, hemorrhagic or corpus luteal cyst. Other conditions i ncluded: ectopic pregnancy, \nuterine fibroid, Pelvic Inflammatory Disease (PID), Tubo-Ovaria n Abscess (TOA), benign cyst \nadenoma & endometriosis. Also rarely, meckel's diverticulum tha t was either incidental finding \nor discovered by imaging techniques. \nKeywords: Surgery, Associated pathologies, Abdomen, Acute appendicitis, Females \n \nIntroduction \nnatomically, vermiform appendix is \nlocated at the base of the cecum, \nnear the ileocecal  valve where the taenea \ncoli converge on the cecum, it is \napproximately 8-10 cm long in adult. \nNormal anatomical variations included; \nretrocaecal/retrocolic (75%), subcaecal \nand pelvic (20%) a nd preileal and \npostileal (5%)\n1,2. \n Acute appendicitis, inflammation of the \nvestigial vermiform appendix, is the most \ncommon cause of acute abdomen in \nyoung adolescents\n3-5. It is a common \ncause of acute abdominal pain in women \nof reproductive age, and appendectomy \nrepresent the most common of all \nemergency surgeries carried out in those \npatients\n6. Because the appendix is \nsituated in close proximity to the uterus, \nright ovary and right fallopian tube, \ninflammation of female reproductive \norgans mimicks acute appendicitis\n7. \nTherefore, especially in women, other \ncauses of abdominal pain should be \nsearched for if the appendix appears \nnormal during surgery. The use of \ndiagnostic laparoscopy followed by \nappendectomy if necessary in fertile \nfemale patients was found to reduce the \nrate of negative appendectomy several \nfolds\n8,9.  \n In female patient in which acute \nabdominal pain is predominant in right \nlower quadrant, acute appendicitis and \ngynecological pathologies are the main \ndisorders to be eliminated (twisted \novarian cyst as an example) and even \ngynecological pathology can simulate \nacute appendicitis and vice versa. Other \ngynecological causes of acute abdomen \ninclude\n11: ovarian cyst (complicated, \ntwisted, ruptured), pelvic inflammatory \ndiseases (PID), tubo-ovarian Abscess \n(TOA), ruptured ectopic pregnancy and \nseptic abortion  \n \nPatients and methods  \n This prospective study was conducted in  \nthe surgical and pathological departments \nin Al-Sadr Teaching Hospital from \nA \nB\nas J Surg, June, 26, 2020 69\n\nAcute appendicitis and associated pathologies in females                                               AH Kadhem, AA Muhsin & WH Al-Sewadi \nFebruary 2018 to January 2020 and it \nincluded 120 female patients of different \nage (15-70) year old who were presented \nto emergency unit with a history of \nabdominal pain, mainly at right iliac fossa \n(RIF). The patients were admitted to the \nsurgical word, routine investigations were \ndone for all including ultrasound study, \nother tests like ECG and pregnancy test \nfor selected cases. \n After the decision for surgery was taken, \nall operations were done under GA by \none resident doctor, all surgically \nremoved appendices and coincidental \npathologies were submitted for \nhistopathological examination in the \ndepartment of pathology. \n All patients were discharged well within \ntwo days without any postoperative \ncomplication.  \n Data analysis includes; age, marital \nstatus, fertility, history of previous \nsurgery, gynecologi cal history and \nhistopathological examination of the \nsurgical specimens.  \n \nResults \n Mean age of female with acute \nappendicitis was 43 years. The peak age \ninterval of a cute appendicitis occurs at \nthe age group between 30 to 35 years, as \nshown in figure 1. \n  \nFigure 1: Age distribution of the patients. \n \n \n \n \n \n \n \n \n \n \n \n \n \n There \nwere 87 (72.5%) cases who are married, 82 (68.3%) out of  87 were fertile and 5 \n(4.1%) were infertile, and 33 (27.5%) cases were single as shown in figure 2.  \n       \nFigure 2: Marital and fertility state of patients.  \n \n \nB\nas J Surg, June, 26, 2020 70\n\nAcute appendicitis and associated pathologies in females                                               AH Kadhem, AA Muhsin & WH Al-Sewadi \nA total of 120 specimens were received in \nthe histopathology department, 52 \n(43.3%) cases were found to have \nappendicitis proven by histopathological \nexamination. Other pathologies were \nMeckel’s diverticulitis, endometriosis, \nbenign cystadenoma of right ovary and \nbilateral chocolate cyst were found as one \ncase for each as shown in table I.\n  \n             Table I: Histopathological diagnosis. \n \nForty seven (39.1%) of cases subjected to histopathological exa mination was right \novarian cyst as show in figure 3. \n         Figure 3: Incidence of ovarian cyst among appendectomy \n \n \n \n \n Most common type of ovarian cyst \nobserved was Corpus luteal cyst in 24 \n(51%) while other types like hemorrhagic \nright ovarian cyst in 9 (19.1%) cases, \nrupture right ovarian cyst in 7 (14.8) \ncases, twisted (torsion) ovarian cyst in 6 \n(12.7%) cases and chocolate cyst in 1 \n( 2 % ) ,  a s  s h o w n  i n  f i g u r e s   4  &  5 .  \n \nB\nas J Surg, June, 26, 2020 71\n\nAcute appendicitis and associated pathologies in females                                               AH Kadhem, AA Muhsin & WH Al-Sewadi \n Figure 4: Types of ovarian cyst discovered during appendectomy. \n \n \nFigure 5: Percentage of ovarian cyst discovered during appendectomy. \n \n \nMeckle's diverticulum (figure 6) was found only in one case(0.8%). \n \nFigure 6: The one case of Meckle's diverticulum. \n \n \nB\nas J Surg, June, 26, 2020 72\n\nAcute appendicitis and associated pathologies in females                                               AH Kadhem, AA Muhsin & WH Al-Sewadi \nDiscussion  \n Acute appendicitis is the most common \nsurgical emergency that has been \nencountered in emergency departments\n12, \nmany diseases resemble its symptoms and \nsigns so thorough history and physical \nexamination included gynecological \nexamination is the key to determine the \netiology of abdominal pain.  \n In this study, 120 female patients were \nincluded, age range from 15 to 70 year,  \nand this is  similar to study performed at \nDiyarbakir Education and Research \nHospital, Turkey in which females with \nages ranging from 15 to 84 years \n(Median, 32.2±15.1 years), and it was \nfound that age incidence of acute \nappendicitis was nearly 70% at 30-35 \nyears. This mean, its peak of incidence at \nthird decade of life in concordance with \nvarious studies, that shown higher \nincidence of appendicitis in the second \nand third decades (80% below 40 years of \nage)\n13-15.  \n The highest associated gynecological \npathology was ovarian cyst which was \nfound in 47 (39%) of cases in which \ncorpus luteal cyst was in the top 51.06% \nwhile chocolate cyst was the minimum \n2%.  \n Meckle's diverticulum (figure 6) was \npresented only in one case (0.8%) in \ncontrast to other study in which its \nprevalence was zero\n15. \n \nReferences  \n \n1. Jaffe BM, Berger DH. The appendix. In: Schwartz's Principles o f  S u r g e r y ,  8 t h  e d ,  S c h w a r t z  S I ,  \nBrunicardi CF (Eds), McGraw-Hill Companies, New York 2005.  \n 2. Buschard K, Kjaeldgaard A. Investigation and analysis of the position, fixation, length and \nembryology of the vermiform appendix. Acta Chir Scand 1973; 139:293.  \n3. P. Ronan O’ Connell. The Vermiform Appendix. Russell RC,Will i a m s  N S ,  B u l s t r o d e  C J ,  ( e d s ) .  I n  \nBailey and Love’s Short Practice of Surgery, 23rd Ed. London, UK: Arnold Publishers 2000; pp 1076-92.  \n4. Rosemary A Kozar, Joel J Roslyn. The Appendix. In: Principle s of Surgery. 7th International edition, \nSeymour I Schwartz, (ed); McGraw-Hill Health Profession Division 1999: pp 1383-94.  \n5. Condon RE. Appendicitis. In: Sabiston DC, ed. Textbook of su rgery. 13th ed. Philadelphia: W B \nSaunders, 1986:967-82.  \n6. Gilmore OJA, Browett JP, Griffin PH et al. Appendicitis and mimicking conditions .Lancet 1966;2: \n1334-1337.  \n7. Flum DR, Koepsell TD. Evalua ting diagnostic accuracy in appe ndicitis using administrative data. J \nSurg Res. 2005;123:257–261.  \n8. Korner H, Sondenaa Karl, Soreide JA et al. Incidence of acut e nonperforated and perforated \nappendicitis: Age-specifi and sexspecifi analysis. World J. Surg 1997;21:313  \n9. Engin O, Calik B, Yildirim M, Coskun A, Coskun GA. Gynecologic pathologies in our appendectomy \nseries and literature review. J Korean Surg Soc 2011;80:267-71.  \n10. Schwartz's Principles Of Surgery, 10th Edition : Free Downl oad, Borrow, and Streaming : Internet \nArchive .  \n11. Storm-Dickerson TL, Horattas MC. What have we learned over the past 20 years about appendicitis in \nthe elderly? Am J Surg. 2003;185(3):198–201.  \n12. Oguntola AS, Adeoti ML, Oyemolade TA. Appendicitis: Trends in incidence, age, sex, and seasonal \nvariations in South-Western Nigeria. Ann Afr Med 2010;9:213-7.  \n13.Noudeh YJ, Sadigh N Ahmadnia AY.Epidemiologic feature,season al variations and false positive rate \nof acute appendicitis in Shahr-e-Rey, Tahran . Int J Surg 2007;5;95-8.  \n14. Nabipour F. Histopathologic Feature of acute appendicitis i n Kerman-Iran from 1997 to 2003. A m J \nEnv Sci 2005;1:130-2.  \n15. Zahra F. Pattern of benign ovarian cysts in Qatari women. Qatar medical journal 2017;2016(2):17\n \nB\nas J Surg, June, 26, 2020 73","source_license":"CC0","license_restricted":false}