CLINICAL, HISTOLOGICAL AND BACTERIOLOGICAL EVALUATION OF ACUTE APPENDESITIS

Abstract

Objective: To ascertain the diagnostic accuracy of clinical findings only, clinical findings
supplemented with limited investigations (CBC & urine C/E), clinical findings routine
investigations and detailed investigations in acute appendesitis. To study the histopathology and
bacteriology of acute appendesitis.
Material and Methods: A Study was carried in department of surgery Services Hospital,
Lahore. 150 patients who were operated for appendisectomy with suspicion of AAwere included.
Patients were randomly allocated 3 groups. Group A clinical findings only, Group B Clinical
findings supplemented with limited investigations(CBC and Urine C/E), Goup C clinical findings &
detailed investigations (investigations done in addition to GR. B.). Before operation patients signs
and symptoms were recorded on specialized Performa on which relevant lab investigation,
operative findings, post op sequeal, result of histological examinations, appendix culture reports
and follow up visits were also recorded. Analysis was done to determine the diagnostic accuracy
of three groups using computer based Epi-info-G-chi square test was used to check the
significance of difference between three groups. .
Results: 150 patients divided in 3 groups were operated for appendisectomy. 50 patients
(group-A) on the basis of clinical suspicion, 50 patients (group-B) on clinical suspicion and routine
investigations (CBC and Urine C/E), 50 patients (group-C) with clinical suspicion, routine
investigations and special investigations (X-ray erect posture and abdominal U/S). Out of 150
patients 111 had acute appendisitis (74%). Diagnostic accuracy was not significantly different
between group A& B, but it was significantly higher in group-C than group-A.
Most prevalent organism found was Klebsiella followed by E.coli. Sensitivity was high in group-A
(94.2%) but only insignificantly high in group-B (95.7%) and group-C (99.6%) specificity was low
in group-A(22.6%) better in group-B (49.4%) and higher in group-C (76.9%).
Conclusion: Appendicitis still remains primarily a clinical diagnosis. With highest rate of
diagnostic accuracy there is highest rate of perforations and via versa. So it can be stated that
although negative findings on laparotomy in suspected acute appendicitis is not without risks, the
hazards of perforated appendix are much more serious.