Acute appendicitis is one of the most common surgical condition, but produces perplexing diagnostic problems, often with atypical findings.
This study is a retrospective and comparative analysis of 866 patients with right lower quadrant abdominal pain, performed at the department of surgery, Kangnam general hospital, public corporation from January 1990 to May 1992. The purpose of
this
study was to improve the diagnostic accuracy of appendicitis.
The results were as follows:
1) In operated cases with the diagnosis of appendicitis, the misdiagnosis rate was 11.5%, and was higher in female(9.78% in male, 13.2% in female).
2) In group 2 patients, who were provened to be other disease with normal appendix in operated cases, three disease(mesenteric lymphadenitis, PID, acute gastroenteritis) were predominent as 62.3% and in group 4 patients, who were observed
without
operation for their obscure diagnosis, above three disease were also predominent as 59.7%. Group 3 patients, who were proven to be normal appendix without other disease in operated cases, were 21 cases.
3) In age distribution, patients under 30 years of age were major percentage in all groups (above 60%).
4) In appendicitis group(group 1 patients), the symptom duration was within 2 days in most cases (74.1%), but in non-appendicitis groups(2,3,4) that of over 3 days was predominent(63.4%)
5) Pain was localized at RLQ in most cases of group 1(72.1%), but in group 2,3,4 patients, RLQ pain with other site pain were predominent(60.9%).
6) In group 3(normal appendix without other pathology in operated cases), G-I symptoms of anorexia, nausea and vomiting were remarkably less frequent (14.2%, 9.5%), in contrast with appendicitis group(80.9%, 55.1%).
7) Shifting of pain was predominent in group 1(61.0%), but in group 2,3,4 patients, shifting of pain was also noted considerably(35.3%).
8) In group 1, the leukocytosis above 10,000mm3 was noted in 81.8% of cases, but was remarkably less frequent in group 3 patients(10.1%). And in group 1, increase of segmented neutrophils over 80% was noted in 90%, but in group 3, it was
remarkably
less frequent(11.1%).
9) In group 1, the positive reaction rate(above 1) of serum C-reactive protein was 91.9%, but in group 3, that was only 6.3%. And group 2, 4 patients showed positive rates in 38.2%, 35.7% of cases.
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