Morphological diagnostic of acute appendicitis and his shapes in environmentally
unfavorable industrial city.
Kapshitar A.V.
Object of research: We want to reveal prevalence concordance and deviation
of terminal clinical diagnosis of acute appendicitis and his shape and his histological
embedding in environmentally unfavorable industrial city.
Material and methods: From 2009 – 2012 it had been operated 218 patients
with acute appendicitis in surgical department of Municipal property «Clinical city
hospital №2» in Zaporizhya. This department is a base of general surgery department
of Zaporizhya State Medical University. In this research it was 114 (52,3 %) male
men, and 104 (47,7 %) female in age 17 – 84. After laparotomy, in macroscopic
results of appendicitis it was determine appendectomy in phlegmon shape 130 (59,6
%) patient, rare – catheral form – 44 (20,2 %), gangrenosa form – 24 (11 %) and
perforated form – 20 (9,2 %). Histological examination of the appendix performed
after conventional treatment of the six transverse sections in places most of the
pathological changes. It was colored by hemotoxylin – eosin. It was used 10 zoom
ocular microscope «Granum».
Results: Histological examination of the removed appendix form Bluetongue
confirmed in 32 (72,7 %) patients, its underdiagnosis occurred in 2 (4,6 %),
corresponding in form of microscopy phlegmonous appendicitis. Acute appendicitis
is excluded during the histology in 10 (22,7 %) patients and chronic appendicitis is
defined in the acute stage.
In patients with a clinical diagnosis of acute appendicitis abscess forms
morphological changes confirmed in 108 (83,2 %) patients, overdiagnosis was
observed in 5 (3,8 %), underdiagnosis - in 5 (3,8 %). Acute appendicitis is excluded
in 12 (9,2 %) patients and chronic appendicitis is defined in the acute stage.
The coincidence of the clinical and pathological diagnosis of gangrenous forms
of acute appendicitis were diagnosed in 13 (54,2 %) patients. Overdiagnosis was
detected in 9 (37,4 %) patients, of which the form was abscess in 8 patients and
catarrhal form – in 1. Underdiagnosis was observed in 1 (4,2 %) patients with
perforated appendicitis form. Very rarely, in 1 (4,2 %) patients, acute appendicitis
was excluded and diagnosed with chronic appendicitis in the acute stage.
Form of perforated acute appendicitis was present in 9 (45 %) patients,
overdiagnosis was observed in 10 (50 %) of which abscess form of appendicitis was
at 4, gangrenous form – in 4 and catarrhal form - in 2. Just rarely, in 1 (5 %) patients
excluded diagnosed with acute appendicitis and chronic appendicitis in the acute
stage.
Clinical and pathomorphological diagnosis of acute appendicitis reveal in
89 %, but 11 % – it was histological eliminated and determined chronic appendicitis
in phase of intensification of pain. Hyper diagnostic was revealed in 11 % cases and
hypodiagnostic – 7,3 %. In comparative evaluation of the accuracy of matching forms
of acute appendicitis during the operation and the subsequent morphological study
found the highest percentage of patients with a form of abscess, 83,2 percent, and the
lowest – in the form of perforated, 45,0 percent. Overdiagnosis was highest in
perforated form, 50,0 %, and underdiagnosis - with phlegmonous form 4,2 %.
Conclusion: The results are indicated that in environmentally unfavorable
industrial city clinical diagnostic shapes of acute appendicitis by laparatomy
insufficient, which is determine to develop and find new methods of the research.
Key words: acute appendicitis, clinical and morphological diagnostic,
environmentally unfavorable industrial city.