Comparative Study of Acute and Perforated Appendicitis

To date, surgery remains the cornerstone in the treatment of appendicitis. However, recent research has revealed that antibiotic treatment might be an appropriate alternative in selected cases [1,2]. Conservative management with antibiotics causes suppression of bacterial infection by regression of lymphoid hyperplasia. Thereby it might prevent ischemia and bacterial invasion in the early stage of appendicitis [3]. The complication rates in conservative management increase with perforation leading to higher failure rates in treatment. This especially holds true for children, in whom antibiotics fail in 15 to 25 percent of cases with perforated appendicitis [4]. Moreover, previous studies have revealed a 3.5 to tenfold increase in mortality rate following perforation [5-7]. Therefore, accurate pre-operative diagnosis of perforation is important. In patients with suspected appendicitis, inflammatory markers like leukocyte count (LC) and C-Reactive Protein level (CRP) provide as much diagnostic information as clinical findings, such as body temperature and duration of abdominal pain [8]. In children CRP values aid in the diagnosis of perforated appendicitis. Whether LC may discriminate simple from perforated appendicitis in the pediatric population remains uncertain [9-13]. Despite previous investigations it remains unclear whether LC, CRP levels and Erythrocyte Sedimentation Rate (ESR) levels combined with body temperature and duration of abdominal pain have a predictive value in diagnosing a perforated appendicitis in unselected patient groups. Aim and Objective