A Combination of Clinical Examination with Specific Biomarkers and Judicious Use of Imaging Modality can Reduce the Rates of Negative Appendicectomy.
DOI:
https://doi.org/10.37506/ijphrd.v11i3.1485Keywords:
Acute appendicitis, Histopathological examination, Rovsing’s sign.Abstract
Background: Acute appendicitis is one of the most common surgical emergencies. Accurate diagnosis of
acute appendicitis is based on careful history, physical examination and laboratory and imaging findings.
Objective: The primary aim is the correlation between clinical, biochemical and radiological assessment in
patients of appendicitis and also to reduce the rates of negative appendicectomy.
Method: The study was carried out in Department of General Surgery, Sir Sunderlal Hospital, IMS and BHU
from September 2015 to July 2017. Total 61 patients of age group 16-65 years and either sex were evaluated
on the basis of predetermined proforma, which included a detailed history, clinical examination, laboratory
investigations and high resolution sonography or CT and histopathology. Sensitivities, specificities, positive
and negative predictive values of TLC, neutrophil percentage, Modified Alvarado Score, CRP, D-dimer,
USG and CT scan were calculated in respect to histopathology finding as a gold standard.
Results: Modified Alvarado scoring (MAS 7-9:Appendicitis definitive) was present in 24 (39.3%) patients.
Raised leucocyte count was present in 49 (80.32%) patients, while neutrophil count above 75% was
present in 47 (77%) patients. Raised CRP was present in 55 (90.16%) patients with cut-off of >3 mg/l
(normal range 1-3 mg/l) while D-dimer was elevated in 44 (72.13%) patients with cut-off of >5 mg/l. On
ultrasonography,(77%) patients were diagnosed as acute appendicitis whereas (83.3%) had diagnosis of
acute appendicitis in CECT abdomen. Histopathological examination was positive in 60 (98.4%) patients.
Conclusion: We concluded that combination of thorough clinical evaluation along with certain routine
biochemical & specific markers and ultrasonography as the primary imaging modality is sufficient in
establishing a diagnosis of acute appendicitis in more than 90% cases.
