Acute Appendicitis – Importance of Clinical Examination in Making a Confident Diagnosis

Objective: To evaluate the importance of clinical examination in the diagnosis of acute appendicitis. Design: An observational and descriptive study. Setting: Department of surgery, Pakistan Institute of Medical Sciences, Islamabad and Islamic International Medical College Hospital Trust, Railway Hospital, Rawalpindi. The period was from October 2001 to January 2003. Patients & Methods: The study includes 160 patients of acute appendicitis who had undergone appendicectomy with preoperative diagnosis of acute appendicitis. They were analyzed prospectively. The parameters evaluated were age/gender, clinical presentation (signs & symptoms) total & differential leucocyte counts and urine microscopy. The operative findings were recorded and the inflammation of the appendix was graded into uncomplicated, complicated and normal. The results were assessed to establish the role of clinical examination and common laboratory tests (leucocyte count & urine microscopy) in the final diagnosis of acute appendicitis. Results: The mean age was 23 years with male to female ratio of 1.6:1. Pain in the right iliac fossa was the most common symptom and tenderness in the right iliac fossa was the commonest physical sign (92%). The total leucocyte count was less than 10,000/mm3 in 38.8% cases and more than 10,000/ mm3 in 61.2% cases. The sensitivity and specificity of raised TLC for acute appendicitis were 80% and 67% respectively. Eighteen out of 35 patients with abnormal urine microscopy had histopathological evidence of acute appendicitis. The overall diagnostic accuracy was 91.8%. Conclusion: Clinical assessment is the best criteria to reach a confident diagnosis. Total leucocyte count and other investigations should be used as diagnostic aid in doubtful cases but they don’t replace the clinical skills of General Surgeons.