I was reading about perferated appendicitis (my wife went through

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I was reading about perferated appendicitis (my wife went through this and developed a very bad infection). I came accross the phrase "clinical appendiceal perforation the wound should be left open." What is a clinical appendiceal perforation? I asked a local doctor and he did not know what was being referred to.

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Hello,

Clinical appendicel perforation is the medical term for a ruptured appendix. It is rarely used. Most physicians simply say ruptured appendix.

WHen the appendix ruptures, the infected contents of the appendix spill into the abdomen, potentially causing a serious infection of the abdomen called peritonitis. I am guessing this is what your wife experienced.

My eight year old daughter had surgery due to a ruptured appendix. Two weeks later her ten year old sister had the same surgey. Talk about coincidence. I know how sick your wife was a result of this.

Here is some info that will explain the complications. Please let me know if you have questions.

http://www.mayoclinic.com/health/appendicitis/DS00274/DSECTION=5

Edited by Two_Westies on June 7 2006 at 10:27 PM

Reply to Deborah's Post: Let me show you the complete paragraph the phrase is in. It seems like clinical appendicel perforation is being contrasted to a ruptured appendix in some way. Here is the complete paragraph:
Open wound management after perforated appendicitis was common practice but, recently, primary closure has been advocated to reduce costs and morbidity. Hospital records from 319 adults who underwent appendectomy from 1993 to 1996 were reviewed to identify surgical wound infections (SWIs) and examine risk factors. Information about age, length of stay (LOS), operative time, white blood cell count, and antibiotic administration were obtained. Perforation was either noted at operation or identified microscopically by the pathologist. If primary wound closure was performed, patients with acute appendicitis and perforation had a 4-fold higher readmission rate, a 5-fold increase in SWI, and twice the LOS compared with patients with acute appendicitis without perforation. Patients with grossly perforated acute appendicitis had no difference in LOS if the wound was treated open or closed primarily. No patient with microscopic perforation and primary wound closure developed SWI. Primary wound closure after acute appendicitis was safe in the absence of clinical perforation. In the presence of clinical appendiceal perforation the wound should be left open.

In my early years as a nurse, it was common practice to see open wound management during various surgeries As technology developed and lapaoscopic techniques were perfected, it became extremely rare to see this open type technique. Although patients may have had less infection post-up, their hospital stay and course of recovery was far longer. With "super" antibiotics available, more and more surgeons opted to close the patient.

The insurance companies had a lot to do with this, the LOS for appendectomy is one day. Utilization review has to approve any additional days with clinical review for medical necessity. So, in many cases the surgeons hands are tied. It is all about saving money.

I would like to see the website link that this info came from to determine where the study or opinion originated. It is really not the"gold standard" when it comes to appendectomy today. Many surgeons feel that the longer a patient remains int he hospital, the higher the risk of a patient developing a staph infection, so in essence you have a double edge sword.

If the doctor that you mentioned this to was not a surgeon, he may not have been aware of this.

Did you discuss it with the surgeon that performed the surgery?

Another factor is, it is not so ,much the technique of the surgery, but also another consideration is how long was the appendix ruptured before the patient was brought to surgery. In the case of my younger daughter, the surgeon was amazed how well she recovered because he said the appendix had ruptured quite a long time prior to the surgery and he stated he was certain she would have an infection.

Edited by Two_Westies on June 7 2006 at 11:40 PM

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