A Study of Clinicopathological Profile in Patients of Appendicular Perforation

Abstract

Introduction: Appendicular perforation is one of the most common surgical emergencies. The diagnosis of appendicular perforation is based on clinical history, examination combined with investigation. Hb, total leukocyte count (TLC), and neutrophil USG CT help in confirming the diagnosis. Methods: A prospective study was conducted on patient coming with appendicular perforation, at a tertiary care center. Included subject underwent a through physical and clinical evaluation. Data were collected in performa and statistical analysis was done by applying the appropriate test. Results: Among 100 cases of operated appendectomy, great number of patients belonged to 11–20 years (40%) with male predominance (72%). Among all, 90% were diagnosed as histopathological examination positive (appendicular perforation). Sixty-nine percent (69%) patients were C-reactive protein (CRP) positive. Increased TLC in 70% of patients and raised neutrophilia in 54% of patients was observed. Out of 100 patients, 86% were USG positive and retrocecal appendix was the most common position. Tenderness at RIF was the most common sign present (100%). Rovsing’s sign was present in 25% cases while 15% cases were noted with obturator test. Majority of them (70%) had score of >7 and were diagnosed as modified Alvarado-positive cases. Conclusion: In our study, the combination of CRP, TLC, and neutrophil count has PPV of 100% which signifies their greater diagnostic accuracy in early diagnosis of acute appendicitis while the NPV after combining this test is 100% which signifies negative appendectomy can be decreased, if appendectomy is avoided in cases where TLC, CRP, and NC are normal.