Document Detail

A fertile-aged woman with right lower abdominal pain but unelevated leukocyte count and C-reactive protein. Acute appendicitis is very unlikely.
MedLine Citation:
PMID:  10552288     Owner:  NLM     Status:  MEDLINE    
BACKGROUND AND AIMS: An uninflamed appendix at appendectomy represents a misdiagnosis. In fertile-aged women, the diagnostic accuracy in acute appendicitis is usually lower than 60%. We studied the role of preoperative leukocyte count and C-reactive protein (CRP) measurements in the diagnosis of acute appendicitis in fertile-aged women with a clinical suspicion of acute appendicitis. In particular, what is the clinical value of unelevated leukocyte count and CRP in excluding acute appendicitis in these patients? METHODS: We calculated the mean leukocyte count and CRP values in (1) 100 consecutive fertile-aged women operated on for a clinical suspicion of acute appendicitis but with an uninflamed appendix found at appendectomy, and (2) 100 consecutive fertile-aged women operated on for a clinical suspicion of acute appendicitis and acute appendicitis found at appendectomy. The percentages of patients with (1) both values unelevated, (2) only leukocyte count elevated, (3) only CRP value elevated, or (4) both values elevated were calculated within the groups A (uninflamed appendix) and B (acute appendicitis). RESULTS: The mean leukocyte value was significantly (P<0.001) higher in patients with acute appendicitis (13.7x10(9)/l) than in those with an uninflamed appendix (10.6x10(9)/l). Similarly, the mean CRP value was significantly (P<0.05) higher in patients with acute appendicitis (42 mg/l) than in those with an uninflamed appendix(29 mg/l). Taken together, 24 patients were operated on for a clinical suspicion of acute appendicitis, although preoperative leukocyte count and CRP values were unelevated. An uninflamed appendix was found in all these patients at appendectomy. CONCLUSION: Although clinical symptoms and signs indicated acute appendicitis, unelevated leukocyte count and CRP values excluded it, with a 100% predictive value in the current study of fertile-aged women. In our patients, 24% (24 of 100) of unnecessary appendectomies could have been avoided by trusting in this finding.
J M Grönroos; P Grönroos
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Langenbeck's archives of surgery / Deutsche Gesellschaft für Chirurgie     Volume:  384     ISSN:  1435-2443     ISO Abbreviation:  Langenbecks Arch Surg     Publication Date:  1999 Oct 
Date Detail:
Created Date:  2000-01-11     Completed Date:  2000-01-11     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  9808285     Medline TA:  Langenbecks Arch Surg     Country:  GERMANY    
Other Details:
Languages:  eng     Pagination:  437-40     Citation Subset:  IM    
Department of Surgery, University of Turku, PB 52, FIN-20521 Turku, Finland.
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MeSH Terms
Abdominal Pain / blood,  etiology*
Acute Disease
Appendicitis / blood,  diagnosis*,  surgery
C-Reactive Protein / analysis*
Diagnostic Errors
Leukocyte Count*
Predictive Value of Tests
Preoperative Care
Retrospective Studies
Sensitivity and Specificity
Reg. No./Substance:
9007-41-4/C-Reactive Protein

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