Evaluation of total leucocyte count, neutrophil diffrential count C-reactive Protein in the diagnosis of acute appendicitis.

Thesis Report.

ABSTRACT: Acute appendicitis is the most common surgical emergency that a surgeon is called upon to treat. The diagnostic challenge posed by acute appendicitis is evidenced by the significant negative laparotomies. The present study was undertaken to evaluate the accuracy of TLC, NDC and CRP estimation in the diagnosis of acute appendicitis and thereby to assess the feasibility of decreasing this diagnostic error. The diagnosis value of TLC, NDC and CRP were evaluated in this prospective study of 100% patients who underwent appendicectomy for suspected acute appendicitis. Histology confirmed the diagnosis in 74 patients, the remaining 26 were found to have normal appendix. CRP estimation demonstrated the best sensitivity (99%) and predictive value of a negative result (98%). Combining the tests by an 'or' rule enhanced the sensitivity to 100%, employing TLC or NDC or CRP level above the reference range, but at the expense of the predictive value of a positive result (68%). The same test combination proved a predictive value of a negative result at 100%, indicating that acute appendicitis is unlikely when these three tests are simultaneously negative. In the study group, 14 out of 26 patients (53.9%) who had a superfluous exploration, had all three tests negative. Also, none of the 74 patients with acute appendicitis had all three tests negative, i.e., the false negative rate was zero. Therefore, estimation of CRP along with TLC and NDC is recommended as a help in reducing the significant rate of negative appendicetomy in patients suspected of having acute appendicitis, without the risk of subsequent complications, thereby reducing morbidity and financial loss related to it.

Eng.