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PubMed1999

[Acute appendicitis in non-contrast spiral CT: a diagnostic luxury or benefit?].

PURPOSE: To evaluate the diagnostic accuracy of thin collimated unenhanced spiral-CT in patients with clinically suspected acute appendicitis and to determine the impact on patient management and overall costs. METHOD: Unenhanced focussed appendiceal spiral-CT was performed in 56 patients (23 women and 33 men) with clinically suspected acute appendicitis. Scans were obtained from the L4 level to the symphysis pubis using 5 mm collimation, 7.5 mm table feed (pitch 1.5) and 4 mm increment without i.v., oral, or rectal contrast material. Prospective diagnoses based on CT findings were compared with surgical (and histopathological) results and clinical follow-up. The effect of spiral-CT on patient management and clinical resources was assessed. RESULTS: 29 patients (10 women and 19 men) underwent appendectomy. Unenhanced spiral-CT was an accurate imaging technique for the initial examination of patients with suspected acute appendicitis with a sensitivity of 95.4% and a specificity 100%, an accuracy of 98.2%, a positive predictive value of 100%, and a negative predictive value of 97.1%. In 27 patients with no evidence of acute appendicitis, an alternative diagnosis could be made in 24 patients by unenhanced spiral-CT. CONCLUSION: Unenhanced spiral-CT is an accurate test to diagnose or to exclude acute appendicitis. Routine appendiceal spiral-CT can improve medical care and reduce the overall costs for patients suspected of having acute appendicitis.

Acute Disease↗
PubMed1996

Appendicitis after blunt abdominal trauma: cause or coincidence?

The association of appendicitis and blunt abdominal trauma (BAT) is an exceptionally rare occurrence with a few case reports in the literature. The main question whether this association is a result of causative or coincidental relationship has not been evaluated among children. A retrospective clinical study was performed to clarify the pathogenesis, incidence, clinical characteristics and outcome of appendicitis diagnosed in children during the hospitalization period following blunt abdominal trauma (BAT). The records of 554 patients with BAT who were admitted to our unit between 1979 and 1993 inclusive were reviewed. Five patients (0.90%), 3 males and 2 females, with a mean age of 9.4 +/- 1.4 were found to have appendicitis. None of these patients had any signs or symptoms related to appendicitis prior to BAT. Bruising and rupture of the mesoappendix were noted in 3 patients while edema and hematoma of appendix and terminal ileum were found in two. Full recovery was achieved in all patients following appendicectomy. Our incidence of 0.90% is statistically significantly higher than the highest incidence rate of appendicitis stated in the literature during childhood (t-test for population proportion, t = 2.892; p < 0.05). We emphasise the possibility of a causative relationship between appendicitis and BAT depending on the clinical characteristics, operative findings, statistically significant high incidence rate and literature review.

Abdominal Injuries↗
PubMed2001

The use of helical computed tomography in pregnancy for the diagnosis of acute appendicitis.

OBJECTIVE: Accurate diagnosis of acute appendicitis in pregnancy by clinical evaluation is difficult. A safe, reliable test was sought to decrease a delay in diagnosis and to avoid unnecessary invasive procedures. A helical or spiral computed tomographic technique has proven to be a very accurate test in the nonobstetric population for the identification of acute appendicitis. We report its use in pregnant patients with suspected acute appendicitis. STUDY DESIGN: All pregnant patients who were undergoing helical computed tomography at our institution from April 1997 to February 1998 for the suspected clinical diagnosis of acute appendicitis were retrospectively reviewed. Helical computed tomography was performed by standard departmental protocol. A positive study was reported if an enlarged appendix, which did not fill with contrast material, was present with periappendiceal inflammatory changes. Outcomes were determined by the results of surgery and pathologic examination or clinical follow-up. RESULTS: Seven patients were identified in the study period. Two patients had positive findings on helical computed tomography, and acute appendicitis was confirmed at laparotomy and by pathologic inspection. There were no further prenatal complications and both patients delivered at term. Five patients had a normal-appearing appendix on helical computed tomography, and all of these patients had resolution of their pain and symptoms. CONCLUSION: Helical computed tomography appears to be a useful, noninvasive test to accurately diagnose acute appendicitis in pregnancy.

Adult↗
PubMed1999

Observer variation in the assessment of the histopathologic diagnosis of acute appendicitis.

BACKGROUND: The objectives of this study were to determine observer variation in the assessment of the histopathologic diagnosis of acute appendicitis. METHODS: Two consultant pathologists independently evaluated 415 appendectomy specimens (set I). After a consensus conference at which the observers unified the criteria of the diagnosis of acute appendicitis, another 396 appendectomy specimens (set II) were evaluated. To calculate the intra-observer variation, one observer evaluated set II once more. Finally, using the consensus diagnosis as the final diagnosis, the diagnostic accuracy of the surgeon, the primary pathology report, and the two observer evaluations was calculated. RESULTS: In set I no difference was found in the level of agreement on the diagnosis of acute appendicitis versus other diagnoses, and a kappa value of 0.85 was obtained. In set II a kappa value of 0.88 was obtained, which was not significantly different from the kappa value in set I. However, the consensus conference did increase the level of agreement on the diagnosis of acute appendicitis. The intra-observer variation was calculated, and a kappa value of 0.88 was obtained. The cases in which the observers disagreed on a positive diagnosis were cases of mild appendicitis. The question remains how many specimens would have shown these changes if all tissue had been developed for microscopy. The observers' diagnoses were the most reliable, and there was a significant decrease in the diagnostic accuracy compared with both the primary pathology report and the surgeon's opinion, the last one being the least accurate. CONCLUSIONS: These observations stress how important it is for the pathologist to discuss the diagnostic criteria of the diagnosis of acute appendicitis and for the surgeon to go back to the patient's record and look up the histopathologic diagnosis.

Acute Disease↗
PubMed2005

A rare cause of acute appendicitis: parasitic infection.

The role of parasitic infection in the aetiology of acute appendicitis has been discussed for more than 100 years. The aim of this retrospective study was to determine the prevalence of parasitic infection in surgically removed appendices, and to identify whether this type of infection is associated with appendicitis. 104 appendices were removed from patients clinically diagnosed with acute appendicitis, and 30 were removed in the course of other surgical procedures. All the operations were performed at Baskent University Adana Hospital between January 1999 and December 2004. Enterobius vermicularis was identified in 4 (3.8%) appendices from patients with clinical appendicitis, and Entamoeba histolytica was detected in 1 (1.0%) appendix from this group. No parasites were found in the 30 appendices that were removed during other surgical procedures. Specimens from 3 of the 4 appendices with E. vermicularis showed no histological evidence of acute inflammation. It is concluded that parasites in the appendix may produce symptoms which resemble acute appendicitis, but parasitic infection rarely causes acute appendicitis.

Acute Disease↗
PubMed2003

The most useful findings for diagnosing acute appendicitis on contrast-enhanced helical CT.

PURPOSE: To evaluate the most useful findings to look for in diagnosing acute appendicitis on contrast-enhanced helical CT. MATERIAL AND METHODS: Appendiceal helical CT scans with intravenous contrast administration (abdomen, 7-mm collimation; abdominopelvic junction, 5-mm collimation) of 71 patients with surgically proven acute appendicitis and 167 patients with alternative diagnoses were reviewed retrospectively. Three radiologists analyzed the following parameters: enlarged appendix (>6 mm in diameter), appendiceal wall thickening, appendiceal wall enhancement, no identification of the appendix, appendicolith(s), appendiceal intraluminal air, intramural air, extraluminal air, periappendiceal fat stranding, extraluminal fluid, phlegmon, abscess, lymphadenopathy, segmental terminal ileal wall thickening, focal cecal apical thickening, focal colonic wall thickening, and segmental colonic wall thickening. The features that best distinguished appendicitis from alternative diagnoses were selected with stepwise logistic regression analysis. RESULTS: Nine CT findings distinguished acute appendicitis from alternative diagnoses (P < 0.05): enlarged appendix (R = 0.739), appendiceal wall thickening (R = 0.525), periappendiceal fat stranding (R = 0.414), appendiceal wall enhancement (R = 0.404), focal cecal apical thickening (R = 0.171), appendicolith(s) (R = 0.157), extraluminal air (R = 0.050), intramural air (R = 0.043), and phlegmon (R = 0.030). Enlarged appendix (sensitivity, 93%; specificity, 92%), appendiceal wall thickening (sensitivity, 66%; specificity, 96%), periappendiceal fat stranding (sensitivity, 87%; specificity, 74%), and appendiceal wall enhancement (sensitivity, 75%; specificity, 85%) showed the statistically most significant association with acute appendicitis. CONCLUSION: On 5-mm-section contrast-enhanced helical CT examinations, enlarged appendix, appendiceal wall thickening, periappendiceal fat stranding, and appendiceal wall enhancement were the most useful findings for diagnosing acute appendicitis.

Acute Disease↗
PubMed2000

Menstruation, the oral contraceptive pill, and acute appendicitis.

OBJECTIVE: To find out if there was any association between histologically confirmed acute appendicitis, menstruation, and the use of the oral contraceptive pill. DESIGN: Retrospective study. SETTING: District general hospital, Scotland. SUBJECTS: 366 consecutive patients (median age 21, range 10-51) with histologically confirmed acute appendicitis during the period 1981-1990 were studied, 314 of whom were having menstrual cycles. 208 patients with physiological menstrual cycle were included in the study, and 82 patients were taking the oral contraceptive pill. INTERVENTIONS: Prospectively collected standardised data using computer assisted diagnosis of acute abdominal pain was used to review patients with histologically confirmed acute appendicitis. RESULTS: Acute appendicitis was confirmed in 17/208 of patients (8%) who were menstruating, which is significantly less than might be expected (p < 0.003). 5/82 (6%) of those taking oral contraception had withdrawal bleeding and acute appendicitis (p = 0.2). CONCLUSIONS: Acute appendicitis is less common among women during physiological menstruation, but no differences are noted during the withdrawal bleeding phase when taking oral contraception.

Acute Disease↗
PubMed2001

Perforated and non-perforated acute appendicitis--one disease or two entities?

OBJECTIVE: To analyse the pattern of clinical presentation of perforated and non-perforated acute appendicitis in 544 unselected patients treated surgically for suspected acute appendicitis; to find out if their presentation differed. DESIGN: Open prospective population-based study. SETTING: Teaching hospital, western Norway. PATIENTS: All 434 patients operated on for suspected acute appendicitis from the catchment area of a single hospital in whom the diagnosis was confirmed. INTERVENTIONS: Appendicectomy; history, clinical findings, and inflammatory markers were recorded in all patients. MAIN OUTCOME MEASURES: Odds Ratio (OR) and 95% confidence interval (CI) obtained by logistic regression analysis of symptoms and signs of acute appendicitis with regard to independent predictors of perforation of the appendix. Receiver operating characteristic (ROC) curve analysis of inflammatory markers. RESULTS: The perforation rate was 20% (n = 88). Perforation was unlikely when abdominal pain was limited to the right iliac fossa, (OR 0.13, 95% CI 0.05 to 0.33). Increased C-reactive protein (CRP) concentration >50 U/L (OR 4.6, 95% Cl 2.44 to 8.75) and greater age (by decade; OR 1.18, 95% CI 1.02 to 1.36) were independent predictors of perforation of the appendix. CONCLUSIONS: Clinical differences between perforated and non-perforated acute appendicitis could be explained by the presence of advanced inflammation in patients with perforated appendicitis. Our data do not support the hypothesis that they are two clinically different diseases.

Acute Disease↗
PubMed1999

Perforating appendicitis: is it a separate disease? Acute Abdominal Pain Study Group.

OBJECTIVE: To find out whether perforated and unperforated appendicitis are separate diseases and can be distinguished clinically. DESIGN: Prospective multicentre study. SETTING: 11 departments of surgery in Germany and Austria. SUBJECTS: 519 patients over 6 years old who had histologically confirmed acute appendicitis between October 1994 and March 1996. MAIN OUTCOME MEASURES: Differences in history, clinical findings, lab results, clinical course and outcome. RESULTS: 92 of the 519 patients (18%) had perforated appendicitis. The following variables were shown by univariate analysis to be significantly more common in the group with perforated appendicitis: rigidity, reduced abdominal wall movement, abdominal distension, reduced bowel sounds (all p<0.001), pale skin (p<0.005), generalised abdominal tenderness, severe abdominal tenderness (both p<0.01), WCC > or =10(9)/L (p<0.05). By multivariate analysis the following variables were significantly more common in the group with perforated appendicitis: age over 50 years (p<0.0001); change in bowel habit and rigidity of the abdominal wall (both p = 0.001); generalised tenderness (p<0.01); male sex (p<0.01); and distended abdomen (p<0.05). Rectal examination failed to make the distinction. CONCLUSIONS: Perforated and unperforated appendicitis behave clinically like two different diseases. They can in most cases reliably be distinguished using clinical criteria alone. Although greater diagnostic accuracy may result in a higher rate of perforation, close observation and timely intervention will only marginally affect the outcome.

Adult↗
PubMed1985

The prevalence of appendiceal fecaliths in patients with and without appendicitis. A comparative study from Canada and South Africa.

Appendicitis is more common in developed than in developing societies and appendiceal fecaliths are thought to have an etiologic role in the disease. The geographic distribution of appendiceal fecaliths was investigated by systematic, intraoperative palpation of the appendix in patients in Toronto, Canada and Johannesburg, South Africa. The incidences of fecaliths found on pathologic sectioning of the appendix in appendicitis patients in both societies were compared. In the Canadian population, the prevalence of fecaliths in patients whose appendices were palpated incidentally was 32% versus 52% for those with appendicitis (p less than 0.01). In the African population, the prevalence of fecaliths in patients whose appendices were palpated incidentally was four per cent versus 23% for those with appendicitis (p = 0.04). The difference in prevalence of incidental appendiceal fecaliths in the two populations was statistically significant (p less than 0.005). The prevalence of fecaliths is higher in developed countries, such as Canada, than in developing countries, such as Africa, and is also higher in patients with than in those without appendicitis. These data support the theory that the low-fiber diets consumed in developed countries lead to fecalith formation, which then predisposes to appendicitis.

Adolescent↗
PubMed1997

99Tcm-HMPAO-labelled white blood cell scans to detect acute appendicitis in older patients with an atypical clinical presentation.

Forty-nine patients (age > 50 years) with an acute abdomen and suspected appendicitis, but with atypical findings, were included in the study. After the intravenous injection of 99Tcm-hexamethylpropylene amine oxime (99Tcm-HMPAO) labelled white blood cells (WBCs), serial anterior images of the abdomen and pelvis were obtained after 30, 60, 120 and 240 min. Any abnormal localization of WBC accumulation in the right lower quadrant of the abdomen equal to or greater than bone marrow activity was considered positive. Twenty-five patients had positive WBC scans, all of whom underwent laparotomy. Twenty-three of these patients were shown to have appendicitis; the other 2 did not. The other 24 patients had a negative WBC scan, 2 of whom underwent laparotomy and were shown to have appendicitis; the other 22 patients did not undergo surgery and showed no evidence of appendicitis during follow-up. The overall sensitivity, specificity, accuracy, positive and negative predictive values of WBC scans for diagnosing appendicitis were as follows: 92.0%, 91.7%, 91.8%, 92.0% and 91.7% respectively. In conclusion, 99Tcm-HMPAO-labelled WBC scans provide a rapid and highly accurate method for diagnosing appendicitis in older patients with equivocal clinical findings.

Abdomen, Acute↗
PubMed1988

Diagnosing appendicitis in children with acute abdominal pain.

Differentiating acute appendicitis from other causes of acute abdominal pain in children frequently remains unsatisfactory. To determine whether initial historical and physical examination findings might predict final diagnoses, 246 patients with complaints of nontraumatic and nonrecurrent acute abdominal pain were studied. All were between three and 18 years of age and had presented to a hospital-based pediatric emergency department. Each family was telephoned an average of 5.1 days after the visit to determine the patient's subsequent clinical course; operative notes and pathology reports were reviewed for patients receiving surgery. Of these patients with acute abdominal pain, both fever and vomiting were present in 18 of the 24 who eventually had diagnoses of appendicitis, compared with 49 of 222 patients with other final diagnoses (P less than 0.01, with negative predictive value 0.97, sensitivity 0.75, and specificity 0.78, but positive predictive value only 0.27). The duration of the pain at presentation and the frequency of other symptoms (eg, diarrhea, dysuria, anorexia, and lethargy) were unrelated, however, to final diagnosis, as was the duration of the pain and whether abdominal tenderness initially was localized or generalized. Nonruptured appendicitis was generally indistinguishable from ruptured appendicitis preoperatively, by both duration and symptoms. Boys were found more likely to have appendicitis (with or without rupture) than girls (18/118 or 15%, vs. 6/128 or 5%, P less than 0.05). In conclusion, fever and vomiting were noted at presentation more frequently in children with appendicitis than in children with other causes of acute abdominal pain.(ABSTRACT TRUNCATED AT 250 WORDS)

Abdomen, Acute↗
PubMed2000

Use of CT scan in the diagnosis of pediatric acute appendicitis.

BACKGROUND: The efficacy of CT scan in the diagnosis of pediatric appendicitis has hot been established. METHODS: Every patient under the age of 18 who was diagnosed and treated for acute appendicitis in the 1 year period from March 1998-March 1999 at Lakeland Regional Medical Center were included. The presentation, laboratory evaluation, imaging evaluation, hospital course, and pathologic evaluation were reviewed. Selected imaging studies were reviewed by an independent radiologist. RESULTS: Forty-six patients were treated for appendicitis; 17 of them received CT scans (37%). The CT scans predicted appendicitis in 9 of 17 cases (sensitivity = 53%). False-negative studies resulted in some morbidity but no mortality. The radiology review indicated that three cases clearly did not demonstrate appendicitis. The other false-negative studies were secondary to either technical or professional factors. CONCLUSION: The efficacy of CT imaging in the diagnosis of acute appendicitis in children has still not been demonstrated. This limited series indicates that if CT scanning is to be used in pediatric patients, more attention to technical and professional factors may be required. Some of these factors, particularly the ingestion of oral contrast, are particularly problematic in small children and may limit the effectiveness of this modality.

Adolescent↗
PubMed2003

Risk factors for adverse outcomes after the surgical treatment of appendicitis in adults.

OBJECTIVE: To define risk factors that predict adverse outcomes after the surgical treatment of appendicitis in Department of Veterans Affairs Medical Centers. SUMMARY BACKGROUND DATA: Risk factors for adverse outcomes after the surgical treatment of appendicitis in adults are poorly defined. Accurate presurgical assessment of the risk of perioperative complications and death is important in planning surgical therapy. METHODS: The VA National Surgical Quality Improvement Program contains prospectively collected and extensively validated data on approximately 1,000,000 major surgical operations. All patients undergoing surgical intervention for appendicitis from 1991 to 1999 registered in this database were selected for study. Independent variables examined included 68 putative preoperative risk factors and 12 intraoperative process measures. Dependent variables were 21 specific adverse outcomes, including death. Stepwise logistic regression analysis was used to construct models predicting 30-day morbidity rate and the 30-day postoperative mortality rate. RESULTS: There were 4163 patients identified. The mean age was 50 years; 96% were male. Sixteen percent of patients had 1 or more complications after surgical intervention. Prolonged ileus, failure to wean from the ventilator, pneumonia, and both superficial and deep wound infection were the most frequently reported complications, accounting for the majority of the morbidity. The 30-day mortality rate was 1.8% (74 deaths). For >50% of the complications reported, the 30-day mortality rates were significantly higher (P < 0.01) for patients with complications than for those without. Thirty-day mortality rates for several complications exceeded 30%, including cardiac arrest, coma >24 hours, myocardial infarction, acute renal failure, bleeding requiring >4 units of red cells, and systemic sepsis. Four preoperative factors predicted a high risk of 30-day mortality in the logistic regression analysis: "completely dependent" functional status, bleeding disorder, steroid usage, and current pneumonia. "Threat to life" or "moribund" American Society of Anesthesiologists classification and more than a 10% weight loss in the 6 months before surgery were associated with a high risk of complications. CONCLUSIONS: Morbidity and mortality rates after the surgical treatment of appendicitis in VA hospitals are comparable with those reported in other large series. Most postsurgical complications are associated with an increased 30-day mortality rate. The models presented here are the most robust available in predicting 30-day morbidity and mortality for VA patients with appendicitis. Furthermore, they provide a starting point for the design of similar models to evaluate non-VA patients with appendicitis using the data the National Surgical Quality Improvement Program is currently gathering from private hospitals.

Adolescent↗
PubMed2004

Innate immunity genes influence the severity of acute appendicitis.

OBJECTIVE: Using acute appendicitis as a model, we tested the hypothesis that polymorphisms in genes involved in host defense can be associated with the severity of local infection-inflammation in humans. SUMMARY BACKGROUND DATA: Innate immunity is the body's front-line system for antimicrobial host defense. Local inflammation is a major innate immune mechanism for containing and destroying microbes, but it may also contribute to tissue injury. METHODS: We studied 134 patients with acute appendicitis treated at an urban hospital. We looked for associations between the severity of appendicitis (uncomplicated vs. perforated or gangrenous), plasma and peritoneal cytokine concentrations, and single nucleotide polymorphisms in genes involved in recognizing bacterial molecules [CD14 (-159 C-->T); TLR4 (896 A-->G)] and in mounting an inflammatory response [IL-6 (-174 G-->C), TNF-alpha (-308 G-->A), IL-1beta (-31 C -->T)]. RESULTS: Ninety-one patients (68%) had uncomplicated appendicitis and 43 (32%) had complicated disease. The SNPs in the CD14, TLR4, IL-1beta, and TNF-alpha genes were not associated with the severity of appendicitis. A strong association was found between C-allele carriage at -174 in the IL-6 gene and decreased risk of complicated disease (adjusted odds ratio = 0.24, 95% CI = 0.07-0.76). Lower plasma and peritoneal fluid IL-6 concentrations in the IL-6 -174 C-carriers than in the GG homozygotes suggest that this polymorphism contributes to decreased IL-6 production in vivo. CONCLUSIONS: Polymorphism in the IL-6 gene was associated with the severity of appendicitis, even after adjustment for duration of symptoms. The risk for developing appendiceal perforation or gangrene may be determined, in part, by variation in the IL-6 gene.

Acute Disease↗
PubMed1986

Bacteroides fragilis is a silent pathogen in acute appendicitis.

The role of Bacteroides fragilis in the pathogenesis of acute appendicitis was studied in 135 patients in four patient groups: normal (17); phlegmonous appendicitis (17); gangrenous appendicitis (75); and septic complications of appendicitis (26). Aerobic and anaerobic bacteria were isolated from all groups and members of the 'B. fragilis group' were the most common anaerobic isolates. The rate of isolation of B. fragilis was similar from normal and inflamed appendices but was significantly higher from those with septic complications (p less than 0.01). Antibodies against B. fragilis were demonstrated in patients of all groups and occurred with similar frequencies in patients with normal and inflamed appendices but at a significantly higher rate in those with septic complications (p less than 0.01). Whereas patients in this latter group showed IgM-antibody responses to B. fragilis only, those with acute appendicitis had IgM antibodies against a wide range of organisms of the 'B. fragilis group' which suggests that B. fragilis does not play a significant role in acute appendicitis but may be a major cause of its septic complications.

Acute Disease↗
PubMedDate not supplied

Acute appendicitis after solid organ transplantation.

Appendicitis has rarely been reported following solid organ transplantation and never following liver transplantation. We reviewed records of all patients who received solid organ transplants at UCLA between 1989 and 2002 and subsequently underwent appendectomy for presumed acute appendicitis. Of nearly 8000 transplant patients, 17 (nine male, eight female) subsequently underwent appendectomy for presumed acute appendicitis. Average age at appendectomy was 37 yrs (range 6-73 yrs). Organ transplants included liver (seven patients), heart (four), kidney (three), kidney-pancreas (two), and heart-kidney (one). The mean interval from transplant to appendectomy was 1064 d (16-2977). Presenting symptoms and signs included abdominal pain in 16 patients (94%); nausea and or vomiting in 15 (88%); right lower quadrant tenderness in 16; and leukocytosis (WBC > 10 000) in 13 (76%). Mean interval from presentation to appendectomy was 0.94 d (range 0-4). Computed tomography (CT) was performed in 16 patients and showed signs of acute appendicitis in 15. Open technique was used in all patients, preceded by laparoscopy in one. Pathology showed appendicitis in 15 patients (one with perforation), serositis in one, and a normal appendix in one. Mean duration of hospitalization was 7 d (range 1-20). Complications occurred in four patients (24%) and included intra-abdominal abscess requiring percutaneous drainage, ventral hernia, small bowel obstruction, and hematuria in one patient each. There were no deaths and no cases of acute rejection during hospitalization. Average length of follow-up was 712 d (range 3-2492). We conclude that appendicitis is relatively rare following solid organ transplantation. CT facilitates prompt diagnosis. The clinical presentation is similar to that of non-transplant patients, but complications are more frequent, and hospitalization is longer.

Acute Disease↗
PubMed1989

Leucocyte count and neutrophil percentage in appendicectomy for suspected appendicitis.

The total leucocyte count (TLC) and neutrophil percentage (NP) were studied prospectively in 1032 patients who underwent appendicectomy for suspected acute appendicitis. On histopathological study of the resected appendices, 97 patients had normal appendices, and 935 patients had acutely inflamed, gangrenous or perforated appendicitis. Statistically more patients with appendicitis had either raised TLC or raised NP compared with patients with normal appendices (P less than 0.001), and also compared with 357 patients who were admitted with right lower quadrant abdominal pain but were not subjected to operation (P less than 0.001). The sensitivity and specificity of raised TLC in diagnosing appendicitis for patients who underwent appendicectomy were 81.4% and 77.3%, respectively. Sensitivity increased when either raised TLC or raised NP were used, but specificity decreased. In contrast, sensitivity decreased when both raised TLC and raised NP were used together, but specificity increased. Raised TLC, preferably combined with raised NP, is a useful diagnostic aid in acute appendicitis. The TLC and NP, however, should only be interpreted in the light of physical findings in patients with suspected appendicitis because these blood tests have false positive and false negative results.

Acute Disease↗