Evidence-based Clinical
Practice Guidelines for
Acute Nontraumatic RLQ
Abdominal Pain and Tenderness and
Acute Appendicitis
What do we do when we encounter a
grossly normal appendix when we operate with a diagnosis of acute appendicitis?
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In a non-immunocompromised patient of any age,
any gender, communicative, coherent, with stable vital signs with acute
nontraumatic right lower quadrant abdominal pain and tenderness, With a primary clinical and preoperative diagnosis
of acute appendicitis, Patient is operated on, What do
we do when we encounter a grossly normal appendix when we operate with a
diagnosis of acute appendicitis? |
|
Non-immunocompromised
patient with preop diagnosis of acute appendicitis. Intraoperative
findings: Appendix grossly normal No peritonitis No gross abnormality noted in the abdomen No definite alternative diagnosis Question: To remove the
appendix or not? |
|
Operational Definition of Terms in the
Issue/Question: Non-immunocompromised
patient with preop diagnosis of acute appendicitis. Intraoperative
findings: Appendix grossly normal No peritonitis No gross abnormality noted in the abdomen No definite alternative diagnosis Question: To remove the
appendix or not? |
|
End-points in
answering the question: During
an operation for acute appendicitis, to remove a grossly normal appendix or
not and why. Approach
in answering the question: Look for frequency of microscopic
appendicitis in grossly normal appendices removed. Look for data that show
consequences of not removing grossly normal appendix. |
|
Tracking: Medline – for international
journal publications
Herdin – for local journal
publications Internet using various search
engines such as AltaVista, Infoseek, Lycos, etc. Retrieval: Retrieval of whole journal article was done through the
various libraries of the Metro Manila medical schools, Department of Science
and Technology (DOST), and acquaintances. Appraisal
(Inclusion Criteria): Appraisal
(Inclusion Criteria): ·
Papers on
finding of normal appendices and what to do with them ·
With data on
histopathologic results of the grossly normal and consequences of leaving
them behind |
|
·
Total no. of
papers and abstracts appraised: 3 ·
Level of
evidences: Level III Evidences Tracking and Retrieval Results:
|
|
Presentation
of Primary Evidences:
See References |
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In view of the
fact that a grossly normal appendix may have microscopic appendicitis or may
be in the early stage of appendicitis in which there is only mucosal
involvement (5-26%), removal of the grossly normal appendix is recommended. This will avoid a
second operation in case the appendix was not removed and the appendiceal
disease process progresses. |
Summary of Answer to Question or
Recommendations:
In a non-immunocompromised patient of any age,
any gender, communicative, coherent, with stable vital signs with acute
nontraumatic right lower quadrant abdominal pain and tenderness, With a primary clinical and preoperative diagnosis
of acute appendicitis, Patient is operated on, What do
we do when we encounter a grossly normal appendix when we operate with a
diagnosis of acute appendicitis? When we encounter a grossly normal appendix during an operation for
acute appendicitis, in the absence of an
alternative diagnosis, REMOVE THE APPENDIX. In view of the
fact that a grossly normal appendix may have microscopic appendicitis or may
be in the early stage of appendicitis in which there is only mucosal
involvement (5-26%), removal of the grossly normal appendix is recommended. This will avoid a
second operation in case the appendix was not removed and the appendiceal
disease process progresses. |
|
Future Research Issues/Questions Arising from Attempts to Answer
Issue: None at the moment |
|
1.
Greason KL, Rappold JF, Liberman MA. Incidental laparoscopic appendectomy for acute right lower quadrant
abdominal pain. Its time has come.
Surg Endosc, 1998 Mar, 12:3, 223-5. 2.
Grunewald B,
Keating J. Should
the 'normal' appendix be removed at operation for appendicitis? J R Coll Surg Edinb, 1993 Jun, 38:3, 158-60
3.
Barrat C;
Catheline JM; Rizk N; Champault GG Does laparoscopy reduce the incidence of
unnecessary appendicectomies? Surg Laparosc Endosc, 1999 Jan, 9:1, 27-31 |
Quick
Reference Guide or Algorithm:
In a non-immunocompromised patient of any age,
any gender, communicative, coherent, with stable vital signs with acute
nontraumatic right lower quadrant abdominal pain and tenderness, With a primary clinical and preoperative diagnosis
of acute appendicitis, Patient is operated on, What do
we do when we encounter a grossly normal appendix when we operate with a
diagnosis of acute appendicitis? When we encounter a grossly normal appendix during an operation for
acute appendicitis, in the absence of an
alternative diagnosis, REMOVE THE APPENDIX. In view of the
fact that a grossly normal appendix may have microscopic appendicitis or may
be in the early stage of appendicitis in which there is only mucosal
involvement (5-26%), removal of the grossly normal appendix is recommended. This will avoid a
second operation in case the appendix was not removed and the appendiceal
disease process progresses. |