Acute appendicitis - laboratory dependence can be misleading : audit of 211 cases | [Journal of College of Physicians and Surgeons--Pakistan : JCPSP • 2001]

Author(s):

1. Kamran Khalid: Department of Surgery, Unit I & II, Jinnah Hospital and Allama Iqbal Medical College, Lahore, Pakistan

2. Noor Ahmad: Department of Surgery, Unit I & II, Jinnah Hospital and Allama Iqbal Medical College, Lahore, Pakistan

3. Omer Farooq: Department of Surgery, Unit I & II, Jinnah Hospital and Allama Iqbal Medical College, Lahore, Pakistan

4. Ishfaq Anjum: Department of Surgery, Unit I & II, Jinnah Hospital and Allama Iqbal Medical College, Lahore, Pakistan

5. Ghulam Akbar Sial: Department of Surgery, Unit I & II, Jinnah Hospital and Allama Iqbal Medical College, Lahore, Pakistan

Abstract:

To evaluate the importance of clinical examination and common laboratory tests in the diagnosis of acute appendicitis. Design: An observational and comparative study. Place and Duration of Study: Department of Surgery, Unit I & II, Jinnah Hospital and Allama Iqbal Medical College Lahore. The period was from June, 1998 to May, 2000. ’ Subjectsand Methods: Two hundred and eleven consecutive patients undergoing appendicectomy from June, 1998 through May, 2000 were analyzed prospectively. The parameters evaluated were demographic data, clinical presentation, total and differential white cell counts and urine microscopy. The operative findings were recorded and inflammation of the appendix was graded into uncomplicated, complicated and normal. In patients with normal appendix other possible diagnoses responsible for the symptoms and abnormal laboratory findings were noted. The results were assessed to establish the role of white cell count and urine microscopy in the diagnosis of acute appendicitis. Results: The mean age was 23.4 years with male to female ratio of 1.4:1. Pain in the right lower quadrant was the most common symptom (71.6%) and tenderness in right iliac fossa was the commonest physical sign (97.6%). The total leucocyte count (TLC) was less than 10,000/mm in 51.7% cases. The sensitivity and specificity of raised TLC for acute appendicitis were 60% and 77% respectively. Eleven (5.2%) out of 16 patients presenting with urinary complaints and altered urine microscopy had acute appendicitis. The overall diagnostic accuracy was 92.4%. Conclusion: The diagnosis of acute appendicitis remains a clinical entity. The junior surgeon must not be influenced by normal leucocyte count or abnormal urine microscopy when strong clinical grounds for acute appendicitis exist

Page(s): 434-437

DOI: DOI not available

Published: Journal: Journal of College of Physicians and Surgeons--Pakistan : JCPSP, Volume: 11, Issue: 7, Year: 2001

Keywords:

Appendicitis Microscopy Leucocytes Urine Leucocyte count

References:

[1] Lloyd DM,Malik K,Ahmad W,Khan A,Waheed I. Bell PAR .1993 .Roleof sequentialeukocytecountsand C- Epidemiology of acuteappendicitis:astudy of 354 reactivperoteinmeasurementisn acuteappendicitis. TheJSurgRIMS, 5 : 31-3.

[2] . .Aresome appendicec tomiesunnecessarya?n analysisof 319 whiteappendices. , 2 : 35-40.

[3] .1999 .doesremovaolf a normalappendixmatterw,hatis the valueof diagnosticaccuracy& is surgicaldelay importantA?nnRCollSurgEng1995;. , 77 : 358-63.

[4] WagnerJM ,Mckinney WP .1996 .CarpenteJrL. , : 1589.

[5] Wilcox RT .1975 .treatmenotf acuteappendicitischanged with new technology?SurgCHnNAm V&TJ1. Lancet, 19 : 1355-70.

[6] .1968 .The leucocytceount. JAMA, 204 : 37.

[7] . .. , 82 : 166-9.

[8] Bowie RD,DJ O"Dee . .Peritoneal cytologyin suspectedacuteappendicitisa:n economic evaluationH. ealth\^A\, 3 : 321-32.

[9] .1989 .. Aids in the diagnosis of acuteappendicitisB. rJSurg, 79 : 774-9.

[10] RafterAyT . .The valueof leucocytceountin thediagnosisof acuteappendicitisB. , 63 : 143-4.

[11] Allen W . .Excessive dependence on the leukocytosisin diagnosing appendicitisA. , 43 : 399-402.

[12] .1994 .The assessmenotf costproducea betteorutcome. Am, 80 : 369-74.

[13] Bagi P,Bud M. .2000 .Laboratorayid in thediagnosonographyfordiagnosingappendiciti sin theatypical sisof acuteappendicitisD. mJSurg, 179 : 379-81.

[14] Peck J,Peck A,Peck C,Peck J. .2000 .The clinicarloleof noncontrashtelicaclomputedtomographyin thediagnosisof acuteappendicitisA. m JSurg, 180 : 133-6.

[15] Banek T .1995 .ltrasoundanalysisand renal dynamic scintigraphyin acuteappendicitis. Urology, 15 : 108-12.

[16] Neff U,Kelemen M.,Would M. .1993 .Appendicitisdiagnosis today: clnicaland ultrasonidceductions. WorldJ Surg 28, 17 : 243.

[17] Syed AS .2000 .stilal clinicadliagno rateof negativeexploratiofnor acuteappendicitis? sis. RakJSurg, 45(1) : 21-4.

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