Role of Laboratory Parameters in Preoperatively Predicting Perforated Appendicitis

Abstract

Acute appendicitis is one of the most common pediatric surgical emergencies. Herewith we present our study to determine the correlation of preoperative laboratory investigations with intraoperative findings and histopathological report in children with appendicitis. A case series analysis of 60 patients undergoing appendicectomy was performed at the Department of Pediatric Surgery in All India Institute of Medical Sciences Jodhpur India from July 2018 to July 2019. Historic records were analyzed. Parameters studied were age, gender, duration of symptoms, total leucocyte counts and C-reactive protein, ultrasonography, intraoperative findings, placement of drain in perforated cases, postoperative duration of antibiotics, and hospital stay. We compared the values of total leucocyte counts and C-reactive protein in perforated and non-perforated cases. Histopathological report of the specimens was retrieved. The mean age of the patients was 11.23 years (range 2–18 years) with a male preponderance of 2:1. The mean total leucocyte count was 16,772 cells/mm3 in the perforated group which was significantly higher than the non-perforated group 10,872cells/mm3 (p value<0.001). Mean C-reactive protein for the perforated group was 104.3mg/L which was significantly higher (p value 0.015) as compared to 40.69mg/L of the non-perforated group. We calculated a cutoff total leucocyte count of 17,930 cells/mm3, and C-reactive protein value of 32.9mg/L was found to be suitable preoperative parameters suggestive of perforated appendicitis. Ultrasonography correctly identified perforated appendicitis in 56% (n=23) patients. The negative appendicectomy rate at our hospital was <5% which is comparable to the previous studies. No significant difference was noted in the post-operative course and duration of hospital stay if drain was placed intraoperatively in perforated appendicitis. Biochemical parameters can accurately predict perforation in appendicitis preoperatively, and we propose administration of higher antibiotics according to perforated appendicitis protocol in patients who initially present with high total leucocyte count and C-reactive protein.