title: A prospective clinical study of the effects of the physical features of the appendix on perforation.
abstract: BACKGROUND
  Acute appendicitis (AA) is one of the most common surgical emergencies, whosepostoperative morbidity and mortality increase significantly when the appendix perforates. The identification of factors that lead to perforation in these patients might effectively reduce morbidity. In this study, factors associated with perforation in AA were examined.
  
  
  METHODS
  The study included sixty patients divided into equal non-perforated and perforated groups. Preoperative body mass index (BMI) and prehospital delay of the patients, the appendix location, presence of fluid or abscesses during surgery, and the appendix wall thickness, root and end diameters, and length in the surgery specimen were compared.
  
  
  RESULTS
  The patients were comprised of forty males and 20 females, with a median age of 27 (range 16-84) years. BMI was significantly higher in the perforated group than the non-perforated group (p=0.039). There was no difference between the groups in terms of the presence of fluid (p=0.792); the presence of abscess was higher in the perforated group (p=0.017). The most common location of the appendix was retrocecal in the perforated group (p=0.007). While there was no difference in the appendix end diameter, root diameter was significantly higher in the perforated group (p=0.041), as were wall thickness (p<0.001) and appendix length (p=0.037).
  
  
  CONCLUSIONS
  BMI, prehospital delay, a retrocecally positioned appendix, presence of an abscess, and appendix wall thickness, root diameter, and length are risk factors for perforation in AA.
authors.affiliation: Department of General Surgery, Zonguldak Atatürk State Hospital, Zonguldak, Turkey. drtanrikulu@hotmail.com.
authors.forename: Yusuf
authors.initials: Y
authors.lastname: Tanrıkulu
authors.affiliation: Department of General Surgery, Zonguldak Atatürk State Hospital, Zonguldak, Turkey.
authors.forename: Gökhan
authors.initials: G
authors.lastname: Yılmaz
authors.affiliation: Department of Emergency Medicine, Bülent Ecevit University Faculty of Medicine, Zonguldak, Turkey.
authors.forename: Ceren
authors.initials: C
authors.lastname: Şen Tanrıkulu
authors.affiliation: Department of General Surgery, Zonguldak Atatürk State Hospital, Zonguldak, Turkey.
authors.forename: Volkan
authors.initials: V
authors.lastname: Temi
authors.affiliation: Department of Biostatistics, Bülent Ecevit University Faculty of Medicine, Zonguldak, Turkey.
authors.forename: Fürüzan
authors.initials: F
authors.lastname: Köktürk
authors.affiliation: Department of General Surgery, Zonguldak Atatürk State Hospital, Zonguldak, Turkey.
authors.forename: Mithat
authors.initials: M
authors.lastname: Çağsar
authors.affiliation: Department of General Surgery, Zonguldak Atatürk State Hospital, Zonguldak, Turkey.
authors.forename: Boran
authors.initials: B
authors.lastname: Yalçın
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001064:Appendicitis / Q000453:epidemiology / Q000473:pathology / Q000503:physiopathology; D001065:Appendix / Q000473:pathology*; D015992:Body Mass Index; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D061665:Time-to-Treatment; D055815:Young Adult