A Simple and Accurate Clinical Triad of Acute Appendicitis

Shafiee, A; Eshagh Hosseini, SJ

A Simple and Accurate Clinical Triad of Acute Appendicitis

Document Type : Original Article

Authors

A Shafiee ¹

SJ Eshagh Hosseini ²

¹ Assistant Professor of General Surgery, Qom University of Medical Sciences, Nekooei-Hedayati Hospital, Qom, Iran

² Assistant Professor, Department of General Surgery, Qom University of Medical Sciences, Shahid Beheshti Hospital

Abstract

Introduction & Objective: Appendicitis is one of the most common operations in general surgery. The best way of diagnosis based on clinical view. Early diagnosis and operation on time reduce complications obviously. In this study the best clinical view of appendicitis investigated and recommended. Materials & Methods: In a cross sectional study all patients suspected to appendicitis that referred to emergency department of Nekui-Hedayati hospital of Qom and managed with one surgeon included to study. Decision making for diagnosis and operation based on clinical symptoms and signs. Data was analyzed with chi-square test in SPSS 20. Results: Of 127 patients 109 p. (85.8%) had clinical triad of abdominal pain, shifting pain to RLQ and RLQ tenderness. Normal appendectomy was 13.4%. on the base of pathology of 109 p. with clinical triad 98 p. (89.1%) had appendicitis with sensitivity of 89.1% , accuracy of 81.9% , positive predictive value of 89.91% and odd ratio of 4.45% (Confidence Interval 95% = 1.395 – 14.229). Conclusions: Clinical triad of abdominal pain, shifting pain to RLQ and RLQ tenderness is the best clinical view of appendicitis and can done operation without any delayed time.

Keywords

Appendicitis

Symptoms

Abdominal Pain

1. Liang MK, Andersson RE, Jaffe BM, Berger DH, The Appendix. In: Andersson DK, Billiar RT, Dunn DL, Hunter JG, Matthews JB, Pollock RE, editors. Schwartz's Principles of Surgery. 10^th ed. New York: McGraw-Hill Education; 2015. P1241-44.

2. Ohle R, O’Reilly F, O’Brien KK, Fahey T, Dimitrov BD. The Alvarado score for predicting acute appendicitis: a systematic review. BMC Med. 2011; 9: 139.

3. Reilly BM, Evans AT. Translating clinical research into clinical practice: impact of using prediction rules to make decisions. Ann Intern Med. 2006; 144:
201-209.

4. Loveland JE. Reginald Heber Fitz. The exponent of appendicitis. Yale J Biol Med. 1937; 9: 509-520.

5. Wagner JM, McKinney WP, Carpenter JL. Does this patient have appendicitis? JAMA. 1996; 276:
1589-1593.

6. McBurney C. Experience with early operative interference in cases of disease of the vermiform appendix. N Y State Med J. 1889; 50: 676.

7. Bower RJ, Bell MJ, Ternberg JL. Diagnostic value of the white blood count and neutrophil percentage in the evaluation of abdominal pain in children. Surg Gynecol Obstet. 1981; 152: 424-426.

8. Terasawa T, Blackmore CC, Bent S, Kohlwes RJ. Systematic review: computed tomography and ultrasonography to detect acute appendicitis in adults and adolescents. Ann Intern Med. 2004; 141:
537-546.

9. Van Randen A, Bipat S, Zwinderman AH, Ubbink DT, Stoker J, Boermeester MA. Acute appendicitis: meta-analysis of diagnostic performance of CT and graded compression US related to prevalence of disease. Radiology. 2008; 249: 97-106.

10. Doria AS, Moineddin R, Kellenberger CJ, et al. US or CT for diagnosis of appendicitis in children and adults? A meta-analysis. Radiology 2006; 241: 83-94.

11. Andersson M, Andersson RE. The appendicitis inflammatory response score: a tool for the diagnosis of acute appendicitis that outperforms the Alvarado score. World J Surg. 2008; 32: 1843-1849.

12. De Castro SM, Ünlü C, Steller EP, van Wagensveld BA, Vrouenraets BC. Evaluation of the appendicitis inflammatory response score for patients with acute appendicitis. World J Surg. 2012; 36: 1540-1545.

13. Flum DR, Morris A, Koepsell T, Dellinger EP. Has misdi - agnosis of appendicitis decreased over time? A population - based analysis. JAMA. 2001; 286:
1748-1753.

14. Flum DR, Koepsell T. The clinical and economic correlates of misdiagnosed appendicitis: nationwide analysis. Arch Surg. 2002; 137: 799-804.

15. Shir Yazdi S.M, Mirshamsi M. H, Jalilimanesh M, Taghavieh A, Haji Esmaeeli M. R, Sehhat Bakhsh M. Closure of Appendectomy Wound Comparing 2 Methods: Subcuticular and Mattress Suture. Iranian Journal of Surgery. 2006; 15(4): 41-46.