Sankaran Nair Kailasanadhan
Appendicitis the most common cause of acute abdomen in surgical practice and appendicectomy is the most common abdominal emergency surgery performed in any surgical hospital. Acute appendicitis and appendicectomy are potent causes of adhesions, which in turn can lead to small bowel obstruction, infertility etc., and hence are a major source of morbidity. This study aims at evaluating the cause of post appendicectomy abdominal pain and the major causes leading to the same. MATERIALS AND METHODS Study Design: Cross sectional study. Inclusion Criteria- All patients presenting with abdominal pain after appendicectomy, during a period of one year from 2005 January to 2006 January were studied. Exclusion Criteria- 1) Pain due to wound infections were excluded from the study. 2) Children aged below 12 were also excluded. Setting - Department of General surgery, Govt. Medical College Kottayam. Kerala. Period of Study- A period of one year from 2005 to 2006. RESULTS Fifty cases of abdominal pain in post-appendectomy patients, who had full details of their appendectomy surgery, were studied during a period of 12 months. Most of the patients were admitted through casualty and only 7 patients were admitted electively. CONCLUSION In this study of 50 patients readmitted for post appendectomy abdominal pain, 35 i.e. 70% had adhesions. Out of the 35 patients with adhesions 20 had small bowel obstruction due to adhesions and bands and 13 of these patients required surgical intervention. Adhesiolysis was done in 8, resection anastomosis in 2, right hemicolectomy was done in 2, and hernia repair in 1. In early appendectomy group (surgery within 48hrs.), the adhesions responded to conservative treatment which shows adhesions were less aggressive in them. In late appendectomy group (i.e. surgery after 48 hours) with perforated appendicitis, negative appendectomy group and extremes of age, aggressive adhesions occurred leading on to surgical intervention.
