Abstract
Introduction: Acute appendicitis (AA) is the most common surgical abdominal emergency. Diagnosis still remains purely clinical and which is still associated with low specificity, with negative findings intra-operatively. This study is undertaken to find out a biochemical investigation to aid in the diagnosis of Acute Appendicitis.
Materials and Methods: We retrospectively reviewed 70 patients recorded over the period encompassing three years (2015-2017) at RL Jalappa hospital and research centre, Tamaka, Kolar with AAhad a pathology report that confirmed the diagnosis of acute appendicitis.
The patients were divided into three groups with group 1 consisting of uncomplicated appendicitis group 2 with complicated appendicitis (perforation and gangrenous), group 3 control group with other causes of abdominal pain for evaluation.
Results: There were 30 patients in group 1, 20 patients in group 2 and 20 patients in the control group (group 3). There were no significant differences between groups in terms of age or gender. Significant differences emerged in leukocyte and NLR. There was a significant difference between group 1 and group 2 in terms of radiological appendix diameter and contamination around the appendix and fluid accumulation (p=0.001). However, a significant difference was not detected between NLR increase and contamination around the appendix, fluid accumulation, or appendix diameter.
Conclusion: We suggest that preoperative NLR is a useful parameter to aid in the diagnosis of acute appendicitis and differentiate between simple and complicated appendicitis, and can be used as an adjunct to the clinical examination.
References
- Brunicardi FC, Andersen DK, Billiar TR. Schwartz’s Principles of Surgery. 9th edition, 2010.
- Başaklar CA. Karın Ağrısıve Akut Apandisit in Bebekve Çocukların Cerrahive Ürolojik Hastalıkları. Palme Yayıncılık. Ankara, 2006:991.
- Eryılmaz R, Şahin M, Alimoğlu O, Baş G, Özkan OV. Negatifapendektomileri Önlemede c-reaktif protein lökositsayımı-nındeğeri. Ulus Travma Acil Cerrahi Derg 2011;7:142-145.
- Binnebösel M, Otto J, Stumpf M, Mahnken AH, Gassler N, Schumpelick V, Truong S. Acute appendicitis. Modern diagnostics-surgical ultrasound. Chirurg 2009;80:579-587.
- Benjamin IS, Patel AG. Managing acute appendicitis. BMJ 2002;325:505- 506 Apendiks Hastalıkları. Nobel Tıp Kitabevleri. İstanbul, 2002:259-270.
- Kalaycı G, Acarlı K, Demirkol K. Genel Cerrahi. I. Cilt Akut Apandisitve Apendiks Hastalıkları. Nobel Tıp Kitabevleri. İstanbul, 2002:259-270.
- Courtney M. Townsend, Jr., MD, R. Daniel Beauchamp, MD, B. Mark Evers, MD and Kenneth L. Mattox, MD. Sabiston Textbook of Surgery, 19th Edition 2012. Chapter 51 The Appendix 1279-1293.
- Sandberg AA, Bahadır MG. Apandisit Üzerine Tarihi Notlar- Akut Apandisitin Ayırıcı Tanısıve Semptomlar. Akut Apandisitte Tanı Tedavive Kanıta Dayalı Cerrahisi. I. Baskı. Avrupa Kitapçılık. İstanbul, 2008:35-65.
- Wilson EB, Cole JC, Nipper ML, Cooney DR, Smith RW. Computed tomography and ultrasonography in the diagnosis of appendicitis: when are they indicated? Arch Surg 2001;136:670-675.
- Markar SR, Karthikesalingam A, Falzon A, Kan Y. The diagnostic value of neutrophil: lymphocyte ratio in adults with suspected acute appendicitis. Acta Chir Belg 2010;110:543-7.
- Yazici M, Ozkisacik S, Oztan MO, Gürsoy H. Neutrophil/lymphocyte ratio in the diagnosis of childhood appendicitis. Turk J Pediatr 2010;52:400-3.
- Mason RJ, Moazzez A, Sohn H, Katkhouda N. Meta-analysis of randomized trials comparing antibiotic therapy with appendectomy for acute uncomplicated (no abscess or phlegmon) appendicitis. Surg Infect (Larchmt) 2012;13:74-84. CrossRef
- Ishizuka M, Shimizu T, Kubota K. Neutrophil-to-Lymphocyte Ratio Has a Close Association With Gangrenous Appendicitis in Patients Undergoing Appendectomy. IntSurg 2012;97:299-304. CrossRef 14. Raftery AT. The value of the leucocyte count in the diagnosis of acute appendicitis. Br J Surg 1976;63:143-4. CrossRef
- Doraiswamy NV. Leucocyte counts in the diagnosis and prognosis of acute appendicitis in children. Br J Surg 1979;66:782-4. CrossRef
- English DC, Allen W, Coppola ED, Sher A. Excessive dependence on the leukocytosis cue in diagnosing appendicitis. Am Surg 1977;43:399-402. 17. Sasso RD, Hanna EA, Moore DL. Leukocytic and neutrophilic counts in acute appendicitis. Am J Surg 1970; 120:563-6. CrossRef
Corresponding Author
Dr Sreeramulu P N
Professor & HOD, Dept of General Surgery, SDUMC Kolar, India