Appendicitis with positive ultrasound and its relation to total and differential leucocytic count

الملخص EN

Background : The most common cause of acute surgical abdomen is acute appendicitis and the most commonly done emergency surgery is appendectomy.

Although a battery of tests and different scoring methods are available for diagnosis of acute appendicitis, it is very difficult to prevent negative explorations for appendicectomy (15-30 %).

None of the tests has satisfactory Sensitivity and specificity that can be relied upon.

Objectives : The aim of the present study was to evaluate the role of total and differential leukocyte count, and ultrasonography (USG) of abdomen in diagnosing acute appendicitis and reducing the rates of negative appendicectomies and to prevent complications like perforation, peritonitis, and the longer the delay between diagnosis and surgery, the more likely is the perforation leading to peritonitis.

In addition, emphasis was given to whether combining the investigations for the same patient would improve the diagnostic accuracy.

Materials and Methods: A total of 76 clinically diagnosed patients of acute appendicitis, posted for emergency appendicectomy were included in the study in General Surgery Department of EL-Salam Hospital.

This study was conducted in the period October 2012 to September 2013.

Preoperatively blood tests for, total leukocyte count, differential leukocyte count (DLC) and USG abdomen were done.

All patients were subjected to histological examination postoperatively, which was taken as the gold standard.

The three investigations results were correlated with histo-pathological examination reports to evaluate their role in diagnosis of acute appendicitis.

Results : In the present study, the US has the highest sensitivity and specificity (90%, 80%) followed by Total leucocytic count (87.5%, 90%), white Neutrophil count (78.75%, 80%).

Combining US and WBC count increases the sensitivity and specificity of the tests (96.25%, 80%).

Conclusion : US contains important diagnostic information and hence should always be included in the diagnostic workup of acute appendicitis.

The sensitivity of WBC count and DLC are low individually, but when combined with US the sensitivity and specificity increases.

When all three tests are negative acute appendicitis is very unlikely and surgery can be safely deferred in these patients thereby reducing the negative appendicectomy rates.