Correlation study between anatomical site of inflamed appendix and clinical presentation

Abstract

Background: The appendix is considered the most variable abdominal organ due to its multiple possible configurations. There is significant controversy surrounding the relationship between the anatomical positions of the appendix and the clinical presentations of appendicitis. Aim of study: This study aimed to investigate the correlation between the anatomical site of the inflamed appendix and its clinical presentations. Methods: A prospective observational study was conducted at the Department of General Surgery, Al-Yarmouk Teaching Hospital, Baghdad, over six months (July 1, 2020 - January 1, 2021). The study included 100 patients presenting with signs and symptoms of acute appendicitis at the outpatient clinic or emergency department. During surgery, the position of the appendix was identified prior to manipulating surrounding structures. The removed appendices were then sent for histopathological examination. Results: The most common anatomical position of the appendix in this study was retrocecal (49%), followed by subserosal (21%). All patients with subserosal or post ileal appendix presented with diarrhea. Constipation was observed in 47.6% of patients with subserosal appendix, while anorexia was present in all patients with pelvic, pre ileal, and post ileal appendices. Shifting pain occurred in 85.7% of patients with subserosal appendix. Obturator sign was observed in 60% of patients with post ileal appendix. Conclusion: Accurate diagnosis of appendicitis and the anatomical position of the appendix relies on a combination of clinical features, investigations, ultrasonography, and intraoperative findings rather than clinical presentations alone.