Abstract
BackgroundRight iliac fossa (RIF) pain is one of the most common modalities of presentation to surgical emergency. It remains a challenge to the treating clinicians to accurately diagnose or to rule out appendicitis.ObjectiveThe aim of the study was to compare the efficacy of clinical impression, biochemical markers, and imaging in the diagnosis of RIF pain with special reference to appendicitis and their implication in reducing the negative appendicectomy rates.MethodsAll patients presenting to casualty with RIF pain were included in the study. Blood investigations including C-reactive protein (CRP), serum bilirubin, white blood cell counts (WBC), and ultrasound (USG) were done. Based on the clinical impression, patients were either posted for appendicectomy or observed in equivocal cases. Patients who had recurrent pain on follow-up underwent appendicectomy or underwent contrast-enhanced computed tomography (CECT) in equivocal cases. Patients who only had a single self-limiting episode with no other alternative diagnosis or had a normal CECT report were included in a non-specific RIF pain group.ResultsThe negative appendicectomy rate was 8.2%. The mean value of WBC counts (9.57x109/L vs 7.88x109/L; p<0.05) and that of serum bilirubin (1.37 mg/dl vs 0.89mg/dl; p<0.05) in the appendicitis and non-appendicitis group, respectively, were statistically significant. The percentage of CRP positivity was higher in the appendicitis group (51.9% vs 15%; p<0.05). The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) for USG (84.2%, 77.17%, 85.4%, and 75.5%), for CRP (51.8%, 85%, 82%, and 57%), for WBC count (45.1%, 88%, 86.6%, and 48.3%), and for serum bilirubin (69.2%, 75%, 81.4%, and 60.5%) were statistically significant between the groups.ConclusionImaging and biochemical investigations including bilirubin can act as useful adjuncts to the clinical diagnosis of appendicitis.
Highlights
A wide range of laboratory investigations, scoring systems, and imaging techniques are available as an adjunct in the diagnosis for the cause of right iliac fossa (RIF) pain
The percentage of C-reactive protein (CRP) positivity was higher in the appendicitis group (51.9% vs 15%; p
White blood cell (WBC) counts and C-reactive protein (CRP) levels are commonly used in the assessment of suspected appendicitis, but their sensitivity and specificity vary widely between different studies
Summary
A wide range of laboratory investigations, scoring systems, and imaging techniques are available as an adjunct in the diagnosis for the cause of right iliac fossa (RIF) pain. White blood cell (WBC) counts and C-reactive protein (CRP) levels are commonly used in the assessment of suspected appendicitis, but their sensitivity and specificity vary widely between different studies. Ultrasound (USG) has traditionally been used as an adjunct in the diagnosis of appendicitis with variable efficacy [1]. The rate of negative appendicectomies varies from 10-15% in different studies [3]. We intend to discuss ways to optimise the use of clinical findings, investigations, and imaging in the diagnosis of the cause of RIF pain with special reference to acute appendicitis. Right iliac fossa (RIF) pain is one of the most common modalities of presentation to surgical emergency. It remains a challenge to the treating clinicians to accurately diagnose or to rule out appendicitis
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