PRACTICAL SCORE TO AID DECISION MAKING IN DOUBTFUL CASES OF APPENDICITIS

Abstract

The acute appendicitis is the most common surgical disease, which can still be a diagnostic problem, the clinical diagnosis is difficult and management errors are frequent with rates of negative explorations reaching 20-40% and adverse events as perforation, and abscess formation correlated with false-negative decision. In this study; we investigated the rate of diagnostic accuracy by histopathologic examination of every removed appendix from hundred consecutive appendectomies to make a score aiding in decision making of doubtful cases of appendicitis. Before operation; every case examined clinically and investigated by abdominal X-ray and some laboratory investigation (Urine analysis, WBCC and differential WBCC). After operation; every removed appendix was sent for histopathologic examination. According to analysis of every factor or variable from data collected from history, examination ( symptom & signs ) , investigations and histopathologic examinatfon to determine the significant differentiating factors for making the score; we found only 7 factors which have been significant according to(x2 ) test in diagnosis of appendicitis and we gave the scores according to comparison between their percentage in positive cases and their percentage in cases proved normal appendices. The most significant factors are; sex, rebound tenderness, guarding, initial site of pain, diarrhea, WBCC, and differential WBCC.