Year: 1945
Type: article
Study design: Observational Study
Abstract: Acute appendicitis is still a very serious problem in spite of widespread propaganda aimed at early treatment and the avoidance of purgation by well-meaning parents in cases of undiagnosed abdominal pain in children.The pverall mortality appears to vary fairly widely in different clinics.Grey Turner (1943) gives his own mortality figures over a period of some years as 3.49%.The figures of Busch and Spivack (1940), Arnheim and Neuhof (1940), and Jennings et at.(1942) vary between 1.8 and 2.2%.Dennis et al. (1942), who reviewed the reports from a number of American clinics, found that the death rate varied between 2.3 and 6.3%, with an average of 4.12%.'Jennings et al. (1942) published tables summarizing the mortality figures from various reviews and found that they varied from Lazzarini's (1937) of 12% to their own of 1.9%.Since the beginning of 1943 up to the present-i.e., the middle of 1945-I have personally dealt with a total of 480 cases of acute appendicitis.During 1943 the cases were treated at Glasgow Royal Infirmary and at an E.M.S. hospital.Since the beginning of 1944 the cases included have been those which came under my care in Greenock Royal Infirmary.In this consecutive series there were two deaths-an overall mortality of well under 0.5%.The series comprises patients of all ages from 4 to 72, and thus represents a very mixed collection 'of appendicitis cases.It is proposed to discuss briefly the treat- ment of these cases in an attempt to evaluate the factors responsible for this low mortality figure. Classification and TreatmentWe have divided the cases into four groups.The general methods of treatment will be discussed with each group. Acute Appendicitis without PeritonitisInto this group fell cases where the appendix was congested but showed little or no fibrinous deposition on its surface.Most of these were admitted within 24 hours of the onset of illness.Histologically there was usually ulceration of a crypt and leucocytic infiltration in the submucosa extending into the deeper parts of the muscularis.The cases were those frequently called acute catarrhal appendicitis.Of our cases 177 belonged to this group.Appendicectomy was carried out in all of them.The mortality was nil, and there were no postoperative complications. Acute Appendicitis with Local Peritonitis
Source: BMJ
Author: A. Lyall
Language: English
Subfield: Emergency Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: bronze
OpenAlex ID: W2017362656