A STUDY OF CLINICOPATHOLOGICAL PROFILE IN PATIENTS OF APPENDICULAR PERFORATION
DOI:
https://doi.org/10.22159/ajpcr.2023.v16i5.49523Keywords:
Appendicular perforation,, Clinicopathological, Modified Alvarado scoreAbstract
Objective: Appendicular perforation is one of the most common surgical emergencies. The diagnosis of appendicular perforation is based on clinical history, examination combined with investigation. Hb, total leukocyte count (TLC), and neutrophil USG CT help in confirming the diagnosis.
Methods: A prospective study was conducted on patient coming with appendicular perforation, at a tertiary care center. Included subject underwent a through physical and clinical evaluation. Data were collected in performa and statistical analysis was done by applying the appropriate test.
Results: Among 100 cases of operated appendectomy, great number of patients belonged to 11–20 years (40%) with male predominance (72%). Among all, 90% were diagnosed as histopathological examination positive (appendicular perforation). Sixty-nine percent (69%) patients were C-reactive protein (CRP) positive. Increased TLC in 70% of patients and raised neutrophilia in 54% of patients was observed. Out of 100 patients, 86% were USG positive and retrocecal appendix was the most common position. Tenderness at RIF was the most common sign present (100%). Rovsing’s sign was present in 25% cases while 15% cases were noted with obturator test. Majority of them (70%) had score of >7 and were diagnosed as modified Alvarado-positive cases.
Conclusion: In our study, the combination of CRP, TLC, and neutrophil count has PPV of 100% which signifies their greater diagnostic accuracy in early diagnosis of acute appendicitis while the NPV after combining this test is 100% which signifies negative appendectomy can be decreased, if appendectomy is avoided in cases where TLC, CRP, and NC are normal.
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Potey K, Kandi A, Jadhav S, Gowda V. Study of outcomes of perforated appendicitis in adults: A prospective cohort study. Ann Med Surg (Lond) 2023;85:694-700. doi: 10.1097/MS9.0000000000000277, PMID 37113955
Sarkar R, Mandal N, Kumar P, Dasgupta A. A prospective study on clinicopathological correlation of perforative peritonitis in a rural based tertiary Care Hospital. IOSR J Dent Med Sci 2017;16:44-8. doi: 10.9790/0853-1605114448
Kar S, Behera TK, Jena K, Sahoo AK. Hyperbilirubinemia as a possible predictor of appendiceal perforation in acute appendicitis: A prospective study. Cureus 2022;14:e21851. doi: 10.7759/ cureus.21851, PMID 35282512
Shirah BH, Shirah HA, Alhaidari WA. Perforated appendix-delay in presentation rather than delay in the surgical intervention: Retrospective database analysis of 2573 Saudi Arabian patients in 10 years. Int J Sci Stud 2016;4:32-6.
Ghag GS, Shukla KS, Shukla DK, Bhalerao UD. A comparative study of perforated and non-perforated appendicitis with respect to clinical findings, radiological findings and post-operative management. Asian Pac J Health Sci 2016;3:5-13.
Maitra D, Basak S, Jindal N, AV, KN, Sharma A. Clinicopathological correlation of hyperbilirubinemia as a predictor of perforation in acute appendicitis. SAS J Surg 2017;3:291-306.
Balogun OS, Osinowo A, Afolayan M, Olajide T, Lawal A, Adesanya A. Acute perforated appendicitis in adults: Management and complications in Lagos, Nigeria. Ann Afr Med 2019;18:36-41. doi: 10.4103/aam. aam_11_18, PMID 30729931
Akhil K. Comparative study of acute and perforated appendicitis. MOJ Surg 2017;5:160-3.
Boyajian H, Majeski V, Flores A, Sturtz D, Baidoun F, Dughayli M. Clinicopathological and perioperative outcome of appendiceal tumors: Case review of 31 patients. Spartan Med Res J 2020;5:13487. doi: 10.51894/001c.13487, PMID 33655185
Pramod T, Prakashkumar MN. Surgical outcome in patients with complicated appendicitis treated at a medical college hospital. Int Surg J 2019;6:2379-85. doi: 10.18203/2349-2902.isj20192959
Paidipelly KK, Sangamitra. Risk factors of acute and perforated appendicitis in a semi-rural population: A retrospective study. Int Surg J 2018;5:2432-6. doi: 10.18203/2349-2902.isj20182488
Kalan M, Talbot D, Cunliffe WJ, Rich AJ. Evaluation of the modified alvarado score in the diagnosis of acute appendicitis: A prospective study. Ann R Coll Surg Engl 1994;76:418-9. PMID 7702329
Asfar S, Safar H, Khoursheed M, Dashti H, Al-Bader A. Would measurement of C-reactive protein reduce the rate of negative exploration for acute appendicitis? J R Coll Surg Edinb 2000;45:21-4. PMID 10815376
Grönroos JM, Grönroos P. Leucocyte count and C-reactive protein in the diagnosis of acute appendicitis. Br J Surg 1999;86:501-4.
Thimsen DA, Tong GK, Gruenberg JC. Prospective evaluation of C-reactive protein in patients suspected to have acute appendicitis. Am Surg 1989;55:466-8. PMID 2742230
Hoffmann J, Rasmussen OO. Aids in the diagnosis of acute appendicitis. Br J Surg 1989;76:774-9.
Peltola H, Ahlqvist J, Rapola J, Räsänen J, Louhimo I, Saarinen M, et al. C-reactive protein compared with white blood cell count and erythrocyte sedimentation rate in the diagnosis of acute appendicitis in children. Acta Chir Scand 1986;152:55-8. PMID 3953219
Marchand A, Van Lente F, Galen RS. The assessment of laboratory tests in the diagnosis of acute appendicitis. Am J Clin Pathol 1983;80:369-74. doi: 10.1093/ajcp/80.3.369, PMID 6881101
Yang HR, Wang YC, Chung PK, Chen WK, Jeng LB, Chen RJ. Role of leukocyte count, neutrophil percentage, and C-reactive protein in the diagnosis of acute appendicitis in the elderly. Am Surg 2005;71:344-7. doi: 10.1177/000313480507100414, PMID 15943411
Verma A, Mehta FS, Vyas KC, Sharma VP, Dhruv AK. C-reactive protein in acute appendicitis. Indian J Surg 1995;3:273-5.
Tantarattanapong S, Arwae N. Risk factors associated with perforated acute appendicitis in geriatric emergency patients. Open Access Emerg Med 2018;10:129-34. doi: 10.2147/OAEM.S173930, PMID 30323692
Naderan M, Babaki AE, Shoar S, Mahmoodzadeh H, Nasiri S, Khorgami Z. Risk factors for the development of complicated appendicitis in adults. Ulus Cerrahi Derg 2016;32:37-42. doi: 10.5152/ UCD.2015.3031, PMID 26985166
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Copyright (c) 2023 Shrikanth M, Nivedita, Mohammed Faizul Viqhas K, Mohammad Noor Alam
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