Early and accurate diagnosis of acute appendicitis (AAp) is still a difficult
problem especially in patients with questionable symptoms and
signs. The current study was designed to determine the accuracy of repeated
total leucocytic counting (TLC) and measurement of serum Creactive
protein (CRP) level in the diagnosis of suspicious Ap and to compare
this with the surgical clinical diagnosis. The study comprised 83 patients
with acute abdominal pain, after clinical examination with special
respect to localization of pain to right iliac fossa, and the presence of rebound
tenderness and abdominal wall guarding, two blood samples were
taken; the first (S1) at admission and the second one 4 hours later (52),
for TLC and estimation of serum concentration of CRP. Histopathologic examination
of the resected appendices disclosed normal appendix (NAp
group) in 13 patients with 16% negative laparotomy rate while 66 patients
had acute appendicitis (AAp group). Abdominal wall guarding is the
most specific clinical finding for AAp with a 95.2% sensitivity, 61.1% specificity
and 88.6% accuracy rate. There was a significant increase in TLC
and CRP value in AAp group compared to NAp group and in 32 sample
versus SI. TLC of 52 sample was specific for AAp with a 98.5% sensitivity,
92.3% specificity and 97.5% accuracy rate. However, CRP showed a
higher sensitivity and specificity in the presence of gangrenous or perforated
appendix (Ap) There was a positive significant correlation between
diagnosis of AAp and TLC 52 sample, (r=0.956, P<0.001). Moreover, there
was positive significant correlation CRP value in 52 sample and pain localization, and abdominal wall guarding (r-1, P<0.001) and the presence
of rebound tenderness (r=0.937, <0.001). In conclusion, the increase
in TLC is an early marker for apperuiiceal inflammation and its persistent
elevation indicating AAp, whereas CRP level usually increases markedly
only with complicated Ap. AAp seems to very unlikely in patients with a
normal TLC and CRP value even if clinical symptoms and signs indicated
AAp. |
