Research Article

Acute Appendicitis: Hispanics and the Hamburger Sign

Garcia Gubern C, Colon Rolón L, Ruiz Mercado I, Oliveras Garcia C, Caban Acosta D, Muñoz Pagán J, Iriarte I, Bolaños Ávila G, Peguero Rivera J, Sánchez Gaetan F, Oneill Castro J, Cordero Colón Paola N, Garcia-Colon Carlos A and Romero-Vazquez Ana M*

Published: 20 November, 2019 | Volume 3 - Issue 2 | Pages: 078-081

Objective: To describe the presenting clinical findings of patients with acute appendicitis and compare them with those described in the medical literature. To corroborate a common medical myth among Hispanic physicians regarding the presentation of acute appendicitis.

Methods: This was a retrospective multicenter chart review of patients diagnosed post-operatively with appendicitis after presenting to five different Emergency Departments in Southern Puerto Rico (PR).

Results: A total of 1,540 patients with pathologically confirmed cases of appendicitis were enrolled in our study. Of the study population, 45% were female, and 55% were male, and 43% were over 21 years old. Reported symptoms in our study showed that 98% of the patients had abdominal pain, 47% had nausea, and only 17.6% presented with anorexia.

Conclusion: It was our main objective to compare the presenting signs and symptoms of patients with acute appendicitis in our Hispanic population in southern PR with those found in primary medical textbooks and literature. We gathered information regarding signs and symptoms, as well as laboratory and radiographic data of patients with positive pathologic exams for appendicitis. Of the 1,540 patients with confirmed appendicitis, only 17.6% presented with anorexia. Our findings demonstrate that the rate of anorexia in the studied population is significantly lower when compared to current literature. The absence of anorexia, once considered a hallmark of appendicitis, must not lead the physician to rule out this diagnosis in the Hispanic population.

Read Full Article HTML DOI: 10.29328/journal.ascr.1001041 Cite this Article Read Full Article PDF


  1. Addiss DG, Shaffer N, Fowler BS, Tauxe RV. The epidemiology of appendicitis and appendectomy in the United States. Am J Epidemiol. 1990; 132: 910-925. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/2239906
  2. Calder JD, Gajraj H. Recent advances in the diagnosis and treatment of acute appendicitis. Br J Hosp Med. 1995; 54: 129-133. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/7582361
  3. Catto JA. Acute Appendicitis, Tintinalli, Ruiz, Krome, Emergency Medicine, A Comprehensive Study Guide, 4th edition. Mc Graw Hill. 1996; 461-463.
  4. Domeier RM. Acute appendicitis. Foresight. 1996; 39: 1-5.
  5. Greenfield RH, Henneman PL. Disorders of the Small Intestine, Appendicitis: Rosen, Barkin, Emergency Medicine, Concepts and Clinical Practice. 4th edition. Mosby. 1998; 2005-2011.
  6. Jess P, Bjerregaard B, Brynitz S, Holst-Christensen J, Kalaja E, et al. Acute appendicitis. Prospective trial concerning diagnostic accuracy and complications. Am J Surg. 1981; 141: 232-234. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/7457743
  7. Liu CD, McFadden DW. Acute abdomen and appendix. In: Greenfield LJ. Et al., eds. Surgery: scientific principles and practice. 2d ed. Philadelphia: Lippincott-Raven. 1997; 1246-1261.
  8. Norton, Steele, Eiseman. Surgical Decision Making. 3rd edition. Saunders. 1993; 154-155.
  9. Orr RK, Porter D, Hartman D. Ultrasonography to evaluate adults for appendicitis: Decision making based on meta-analysis and probabilistic reasoning. Acad Emerg Med. 1995; 2: 644-650. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/8521213
  10. Paulman AA, Huebner DM Forrest TS. Sonography in the diagnosis of acute appendicitis. Am Fam Physician. 1991; 44: 465-468. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/1858603
  11. Rao PM, Rhea JT, Rao JA, Conn AK. Plain abdominal radiography in clinically suspected appendicitis: diagnostic yield, resource use, and comparison with CT. Am J Emerg Med. 1999; 17: 325-328. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/10452424
  12. Ricci Ma, Trevisani MF, BeckWC. Acute appendicitis: a 5-year review. Am Surg. 1991; 57: 301-305. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/2039128
  13. Roake JA, Morton J. Acute appendicitis: a quality assurance analysis. NZ Med J. 1983; 96: 788-790. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/6578449
  14. Rypins EB, Evans DG, Hinrichs W. Tc-99m-HMPAO white blood cell scan for diagnosis of acute appendicitis in patients with equivocal clinical presentation. Ann Surg. 1997; 226: 58-65. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/9242338
  15. Sabiston Jr DC. Appendicitis, Sabiston, Textbook of Surgery. The Biological Basis of Modern Surgical Practice. 1997; 964-970.
  16. Schulte B, Beyer D, Kaiser C, Horsch S, Wiater A. Ultrasonography in suspected acute appendicitis in childhood: report of 1285 cases. Eur J Ultrasound. 1998; 8: 177-182. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/9971899
  17. Schwartz SI. Appendix. In: Schwartz SI, ed. Principles of Surgery. 1994; 1307-1318.
  18. Temple CL, Huchcroft SA, Temple WJ. The natural history of appendicitis in adults: a prospective study. Ann Surg. 1995; 221: 728-781. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/7717781
  19. Wilcox RT, Traverso LW. Have the evaluation and treatment of acute appendicitis changed with new technology. Surg Clin North Am. 1997; 77: 1355-1370. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/9431344


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