Predictive value of leucocyte count, C-reactive protein, ultrasonography and laparoscopy in the diagnosis of acute appendicitis in children

Abstract EN

Background : At times, making the diagnosis of acute appendicitis may pose a considerable problem.

However, prompt and accurate diagnosis is essential to obtain minimal morbidity.

Diagnostic mistakes result either in delayed initiation of adequate therapy or unnecessary operations.

A number of new strategies and diagnostic procedures have been developed and refined, including leucocyte count, C-reactive protein (CRP), ultrasonography (US) and diagnostic laparoscopy.

The aim of this study is to evaluate the usefulness and limitation of these modalities and discuss their clinical impact in the diagnosis of clinically suspected acute appendicitis in children.

Patients and Methods : In a prospective study? The mean preoperative leucocyte count? C-reactive protein value, ultrasonographic outer appendiceal diameter and diagnostic laparoscopy (when needed) in 120 children suspected of having acute appendicitis were studied.

The patients were divided into 3 Groups : Group I ; patients with history and clinical examination suggesting appendicitis with normal leucocyte count, negative CRP and normal US, Group II ; patients with an uncomplicated acute appendicitis? and Group III ; patients with complicated acute appendicitis.

Results : Diagnostic laparoscopy allowed the physician to correct the preoperative suspected diagnosis of acute appendicitis in'7 patients belonging to group I, thus preventing an unnecessary appendicectomy, the study also revealed a significant increase in the leucocytic count and outer appendiceal diameter in Groups II and III, compared to Group 1.

Moreover, there was a significant increase in CRP in Group III compared to Groups I and II.

Conclusion : The increase in leucocyte count and ultrasonographic outer appendiceal diameter were an.

early marker of appendiceal inflammation? whereas the CRP value increased markedly only after appendiceal perforation or abscess formation.

Acute appendicitis is unlikely when leucocyte count, CRP value are normal and ultrasonographic outer appendiceal diameter is less than 6 mm.

Diagnostic laparoscopy for suspected appendicitis is a safe and accurate.