TH6.9 Does the management of right iliac fossa pain vary between men and women?

Abstract

Abstract Aims Recent studies have suggested that women are more likely to suffer a bad outcome after surgery compared to men with similar findings in healthcare areas including pain management and diagnosis. This study aimed to assess the management of female patients with right iliac fossa (RIF) pain. Methods Patients who presented to a DGH general surgical unit with RIF pain from March to October 2020 were identified from a prospectively maintained database of admissions. Clinical parameters, management and final diagnosis were recorded. Minimum follow-up was 12 months (October 2021) to identify re-admissions and morbidity. Results There were 417 patients; 274 (66%) were women. Women were more likely to have an ultrasound (39% vs. 4%, P<0.001) and less likely to have a CT (60% vs. 67%, P=0.250), though they had the same proportion of normal CT imaging (33% vs. 34%). Men were more likely to undergo surgery (49% vs. 29%, P<0.001) but, despite this, women were more likely to have a diagnostic laparoscopy alone or a normal appendix after appendicectomy (15% vs. 4%). The proportion of women without a definitive diagnosis was greater (39% vs. 32%, P=0.024) and only 4 women were referred on for further investigations leading to a greater proportion of re-admissions with ongoing pain amongst women. Conclusions More women than men with RIF pain did not have a diagnosis and women were more likely to have ‘unnecessary’ surgery. Closer attention to gynaecological past medical history or symptoms may improve diagnostic yield and management of women with RIF pain.