J Korean Soc Emerg Med.  2021 Apr;32(2):134-142.

Risk factor leading to complicated appendicitis: pelvic position of the appendix

• Koh H
• Yang H
• Cho K
• Jung YY
• Chang YS
• Kim DH
• Kim MS

Abstract

Objective
Several factors contribute to the progression of complicated appendicitis (CA) in patients diagnosed with acute appendicitis. The goal of this study was to investigate whether the pelvic location of an appendix may be a new prehospital risk factor associated with CA.
Methods
The study retrospectively reviewed 375 patients who underwent surgery for appendicitis from January 2013 to December 2013. Patients were divided into two groups: patients diagnosed with uncomplicated appendicitis (UA) and patients with CA. Demographics, clinical and laboratory findings, duration of symptoms, and the location of the appendix were evaluated. Univariate and multivariate statistical analyses identified risk factors leading to CA.
Results
Of the 375 patients, 46 (12.3%) had CA. The univariate analysis confirmed that the patients diagnosed with CA had a higher body temperature (BT), longer duration of symptoms (DOS), and complained of left lower quadrant abdominal (LLQ) pain more frequently. Furthermore, compared to the UA group, the appendix was more frequently located in the pelvic region in the CA group. Multivariate analysis confirmed that BT >37.5°C (odds ratio [OR], 3.29; 95% confidence interval [CI], 1.64-6.61; P<0.01), LLQ pain (OR, 2.78; 95% CI, 1.16-6.69; P=0.02), DOS ≥48 hours (OR, 3.87; 95% CI, 1.94-7.71; P<0.01), and the pelvic location of appendix (OR, 3.18; 95% CI, 1.49-6.75; P<0.01) were risk factors for CA.
Conclusion
The pelvic location of an appendix may be a new prehospital risk factor associated with CA.

Keyword

Appendix; Appendicitis; Risk factors; Pelvic location