Intra-abdominal pressure: A simple, yet reliable indicator for the diagnosis and prognosis of appendicitis

• Main Authors: Raghuveer Reddy, Gurjit Singh
• Format: Article
• Language: English
• Published: Wolters Kluwer Medknow Publications 2014-01-01
• Series: Medical Journal of Dr. D.Y. Patil University
• Subjects: Appendicitis; bladder pressure; intra-abdominal pressure
• Online Access: http://www.mjdrdypu.org/article.asp?issn=0975-2870;year=2014;volume=7;issue=2;spage=166;epage=169;aulast=Reddy

Introduction: Appendicitis is one of the more common surgical emergencies and it is one of the most common causes of an acute abdomen. Left untreated, appendicitis has the potential for severe complications. Despite initial optimism, it has become apparent that in most units the normal appendix rate remains 15-30%. In view of this scenario, this study was undertaken to assess the role of intra-abdominal pressure (IAP) in the diagnosis and prognosis of acute appendicitis. Materials and Methods: A total of 200 patients with initial diagnosis of appendicitis were evaluated. Patients were grouped according to the final diagnoses as appendicitis (acute and acute on chronic), perforated appendicitis and negative exploration for appendicitis. A simple fluid column manometry system through the Foley′s catheter is used to measure the IAP. Results: Out of a total of 200 cases 104 were female and 96 were male in the age range of 7-74 years. A normal appendix was found in 18 patients and 124 patients had appendicitis. A total of 58 cases were of appendicular perforation. The mean pre-operative values of IAP for cases of normal appendix, appendicitis and appendicular perforation were 3 ± 0.4, 8.2 ± 0.4 and 9.6 ± 0.3 respectively (P < 0.001). Post-operative 1 st day and 2 nd day values of the IAP for appendicitis, perforated appendicitis and normal appendix groups were 3 ± 0.2 and 1.0 ± 0.1, 4.2 ± 0.1 and 1.5 ± 0.1, 0.8 ± 0.6 and 0.5 ± 0.6 cm H 2 O respectively. Conclusion: IAP increases among patients with appendicitis and a further increase is encountered among patients with perforated appendicitis. Therefore, addition of this parameter to support the clinical diagnosis of acute appendicitis and perforative appendicitis is advocated specially in a rural setting. However, randomized controlled trials are required to support our findings.