الفهرس 
Review of LiteratureOnly 14 pages are availabe for public view
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Abstract
P
eritonitis is inflammation of the peritoneum is a silk-like membrane that lines your inner abdominal wall and covers the organs within your abdomen that is usually due to a bacterial or fungal infection.
There are two types of peritonitis: primary spontaneous peritonitis, an infection that develops in the peritoneum; and secondary peritonitis, which usually develops when an injury or infection in the abdominal cavity allows infectious organisms into the peritoneum. Both types of peritonitis are life-threatening. The death rate from peritonitis depends on many factors, but can be as high as 40% in those who also have cirrhosis. As many as 10% may die from secondary peritonitis.
Peritonitis requires prompt medical attention to fight the infection and, if necessary, to treat any underlying medical conditions. Peritonitis treatment usually involves antibiotics and, in some cases, surgery. Left untreated, peritonitis can lead to severe, potentially life-threatening infection throughout your body.
A common cause of peritonitis is peritoneal dialysis therapy. If the patient is receiving peritoneal dialysis therapy, you can help prevent peritonitis by following good hygiene before, during and after dialysis.
Acute appendicitis (AA) is among the most common causes of secondary generalized peritonitis. It is a common surgical disease that is well-studied with an overall mortality rate of 1%. However, it can lead to perforation and subsequent complications such as peri-appendiceal abscess or peritonitis, especially if disease recognition and management are delayed. In the case of perforation, the mortality increases nearly six-fold.
One of the more common complications and most important causes of excess morbidity and mortality is perforation, whether it is contained and localized or unconstrained within the peritoneal cavity. In contrast to the trend observed for appendicitis and appendectomy, the incidence of perforated appendicitis which leads to secondary generalized peritonitis (" ~ "20 cases per 100,000 person-years) is increasing.
Better access and the good imagining of the peritoneal cavity through small openings give laparoscopic appendectomy benefits when compared with an open approach. So, complicated appendicitis is well managed by laparoscopic technique.
The study is aimed to establish, through the available literature, incidence of complicated appendicitis in cases of generalized peritonitis explored for obscure cause through systematic review and meta-analysis.
This is Meta-analysis study, conducted on cases of secondary generalized peritonitis in adults and elderly all over the world and underwent for exploratory laparotomy for unknown cause. The literature search yielded 1821 unique articles. A further screening of titles and abstracts was conducted, and 32 studies were considered potentially relevant to our review. According to the inclusion criteria, 14 studies were identified in this study.
The main results of the study revealed that:
All included studies reported the incidence of complicated appendicitis in cases of unknown generalized peritonitis. The sample size ranged from 77 to 4618 patients. The age of patients ranged from 23.2 to 45.5 years. Males were more predominant than females except in Doklestić et al. (2014) study.
All included studies reported the events of appendicitis as a most common cause of peritonitis. The second most common cause was from duodenal origin, followed by small bowel then stomach origin that was peptic ulcer.
Among studies study 3, 4,5,6,8 and 10-14 reported the presence of comorbidities. All studies showed BMI ranged from 22 to 29.7.
studies showed appendix size ranged from 9.2 to 15 mm. Most of studies showed that patients had appendicolith.
Among patients represented in these studies, the most common reported complication was intra-abdominal abscess, followed by wound infection. Studies 11 to 14 reported death among cases.
Incidence of complicated appendicitis in cases of unknown cause secondary generalized peritonitis ranged from 3.5% to 55.24%.
Age, duration of pain, presence of an appendicolith, size of appendix and abscess were significant predictors to complicated appendicitis.
Abdomino-pelvic U/S, abdominal CT and diagnostic laparoscopy are significant diagnostic tools for decreasing the incidence.
Lack of experience and investigations, late referral to surgery ER, abuse of antibiotics and analgesics without medical consultation and neglected mentally-ill patients will increase the incidence of complicated appendicitis in cases of unknown cause secondary peritonitis.
CONCLUSION
T
here are still a lot of cases of complicated acute appendicitis that was accidentally discovered in cases of generalized peritonitis explored for obscure cause.
Age, duration of pain, presence of an appendicolith, size of appendix and abscess were significant predictors to complicated appendicitis.
Decreased healthcare facilities and investigations, low experience for medical service provider, ignorance, low socio-economic state, decreased awareness and mentally-ill patients will worsen the case and make it difficult to diagnose the main cause of secondary generalized peritonitis which will lead to increase the incidence of accidentally discovered complicated appendix in such cases.
The incidence decreased if the accurate cause of secondary peritonitis was diagnosed early and proper clinical examination followed by proper investigations were done for the patient via expert doctors.
RECOMMENDATIONS
Increasing awareness of patients will be the access to early diagnosis.
Consultations with specialists are very important.
Developing facilities in rural medical centers and continuous training and education for primary physician, these factors will lead to early diagnosis of such cases and to make differentiation of complicated appendicitis from other causes of generalized peritonitis more easily.
Encouraging relatives for early seeking for medical advice and management of such cases to decrease complications and just a usual appendectomy will be better than exploration.
Healthcare authorities must put restriction and rules for seeking medical advice in pharmacies to decrease unprescribed antibiotics and analgesics abuse without examination and sufficient investigations by a specialist doctor for choosing the proper management either medical treatment or surgical interference.