Haydarpaşa Numune Eğitim ve Araştırma Hastanesi, Genel Cerrahi Kliniği, İSTANBUL


The perforation of acutely inflamed appendicitis causing regional and systemic dissemination of a focal infection is a turning point negatively affecting clinical course, development of complications, and patient's outcome. To determine and to eliminate risk factors leading to perforation, and to be aware of and well-informed about the risk will be favourable for such patients. In this study we aimed to investigate age and sex-specific effects on the occurrence of perforation and intraabdominal sepsis due to acute appendicitis, and on the postoperative morbidity and mortality. We retrospectively reviewed hospital charts of patients with acute appendicitis who were subjected to appendectomy. 326 patients with perforated appendicitis were devided and analysed into three groups as the childhood, the adults and the elderly. We evaluated age and sex-specific effects on the incidence of appendicitis, perforation rate, postoperative complications and patient's outcome. Of 326 perforated cases 219 (67.2%) were male and 107 (32.8%) female with an average age of 27.8 years. The rate of perforation was 12.7%. This rate was 17.7% (p<0.001) and 38.5% (p<0.001) in groups of the childhood and the elderly respectively. The childhood and the elderly groups consisting 35.3% of all appendicitis cases, were 56.1% (p<0.0001) of perforated cases. Sex distribution did not significantly affected the occurrence of perforated appendicitis. The total morbidity was 32.8% in all cases, and 73.8% (p<0.0001)in the elderly. The number and severity of postoperative complications has increased with advancing age. The mortality in the early postoperative period was 1.5% (5 patients). All fatal outcomes were determined in patients older than 50 years of age (5/42; 11.9%). The mortality was related to pre-existing concomitant serious systemic diseases and disorders aggravated by intraabdominal sepsis. In conclusion, the gender is not an effective factor on the unfavourable progress of appendicitis, and on the undesirable outcomes of such patients. The age (younger age under 15 years, advanced age older than 50 years) is a significant risk factor on the occurrence of perforated appendicitis. According to age distribution, the perforation rate increases inversely proportional to decreasing incidence of acute appendicitis. By other words, in the childhood; lower incidence of appendicitis, higher perforation rate; in the elderly lowest incidence, highest rate are most prominent results. Advanced age (together with age-related concomitant diseases) is a significant risk factor on postoperative morbidity and mortality.