FACTORS ASSOCIATED WITH PERFORATION IN ACUTE APPENDICITIS: AN INTEGRATIVE LITERATURE REVIEW

Abstract

Acute appendicitis is one of the most common abdominal surgical emergencies, and its progression to perforation is associated with increased morbidity, longer hospital stays, and a higher risk of complications. This study aimed to identify the main factors associated with perforation in acute appendicitis through an integrative literature review. A search was conducted in the PubMed and Virtual Health Library (VHL) databases using the descriptors “Acute Appendicitis”, “Perforation”, and “Predictors”, covering publications from 2021 to 2026. After applying the eligibility criteria, 23 studies were included in the final analysis. The results demonstrated that appendiceal perforation has a multifactorial nature, involving clinical, laboratory, radiological, and healthcare access-related factors. The most frequently reported findings were longer symptom duration, fever, leukocytosis, elevated C-reactive protein levels, hyponatremia, and increased appendiceal diameter. Furthermore, the presence of fecalith or appendicolith, periappendiceal collection, diabetes mellitus, obesity, chronic kidney disease, and delayed diagnosis were also associated with a higher risk of perforation. It is concluded that the early recognition of these factors may contribute to risk stratification, timely diagnosis, and the adoption of more appropriate therapeutic approaches, helping to reduce the morbidity associated with complicated acute appendicitis.