Raised faecal calprotectin levels in pateints presenting with right iliac fossa pain warrant mandatory laparoscopy: A non-invasive predictor of acute appendicitis

Introductions: Cases of colic of the vermiform appendix have been rarely described or diagnosed. Appendicoliths cause acute appendicitis and appendicular perforation. It is still not clear whether appendicoliths cause appendicular colic in the absence of acute appendicitis. Methods: A cross sectional study that included appendectomy done for recurrent appendicitis or chronic right iliac fossa pain. Histology reports were reviewed. The presence of an appendicolith in the report was noted. Results: Thirty-two cases of recurrent appendicitis and chronic right iliac fossa pain were included. Twenty-four patients (75%) had fecoliths in the histology specimens. Eight patients (25%) who presented with appendicular colic without signs of appendicitis were further evaluated. Conclusions: Majority of patients with chronic or colicky right iliac fossa pain had appendicoliths.

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Report Of A Case Of Abdominal Burkitt's Lymphoma Presenting As Localised Right Iliac Fossa Pain Mimicking Acute Appendicitis

The Internet Journal of Surgery ◽

10.5580/823 ◽

2007 ◽

Vol 9 (1) ◽

Cited By ~ 1

Keyword(s):

Acute Appendicitis ◽

Iliac Fossa ◽

Burkitt’S Lymphoma ◽

Burkitt's Lymphoma ◽

Right Iliac Fossa Pain

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ACUTE APPENDICITIS

The Professional Medical Journal ◽

10.29309/tpmj/2016.23.03.1465 ◽

2016 ◽

Vol 23 (03) ◽

pp. 241-245

Author(s):

Javeria Farid ◽

Rizwanullah Junaid Bhambhro ◽

Sohail Soomro

Keyword(s):

Abdominal Pain ◽

Postoperative Complications ◽

Acute Appendicitis ◽

Epigastric Pain ◽

Iliac Fossa ◽

University Hospital ◽

Cross Sectional ◽

Clinical Pattern ◽

Rebound Tenderness ◽

Right Iliac Fossa Pain

Objectives: To determine the clinical presenting pattern and postoperativecomplications of acute appendicitis. Study design: Observational and cross-sectional study.Setting: Isra university hospital Hyderabad. Period: 7 months. Methodology: All the patientsabove 12 years of age and both genders male/female after diagnosis of acute appendicitishad integrated in the study. Complete clinical pattern and postoperative complications hadrecorded. Results: Symptoms/sign nausea, vomiting, anorexia, rebound tenderness, fever,constipation, diarrhea and leukocytosis were noted with the percentage 98.0%, 65.0%, 95.0%,90.0%, 85.0%, 58.0%, 30.0% and 89.0% respectively. Paraumblical pain was noted in 50.0%of the cases, right iliac fossa pain was in the 99.0%, epigastric pain was seen in 61.0% and theother abdominal pain was noted in the 39.0%. Postoperative complications found in 33.0% ofthe cases and majority was seen wound infection. Conclusion: In the conclusion of this studyclinical features nausea, vomiting, anorexia, rebound tenderness, fever, and leukocytosis wereseen as most common and the most important postoperative complication is infection whichprobably created with the uncompleted sterilization.

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EP.WE.641Spectrum of Right Iliac Fossa Pain Presentation and Management During the First COVID-19 Lockdown: A Single Institution Experience

British Journal of Surgery ◽

10.1093/bjs/znab308.081 ◽

2021 ◽

Vol 108 (Supplement_7) ◽

Author(s):

Ahmed Salman Bodla ◽

Chinedu Ndegbu

Keyword(s):

Acute Appendicitis ◽

Diagnostic Imaging ◽

Imaging Modality ◽

Iliac Fossa ◽

Management Approach ◽

Conservative Approach ◽

Diagnosis Rate ◽

Right Iliac Fossa Pain ◽

Management Approaches ◽

Surgical Unit

Abstract Aims Acute surgical presentations and management approaches have witnessed a changing pattern occasioned by COVID-19 pandemic and attendant lockdown. We report the spectrum of right iliac fossa (RIF) pain referrals and management trend within an acute surgical unit before and during the National lockdown. Methods A retrospective review of all patients referred to the acute surgical unit with RIF pain before and during first National lockdown was undertaken. Patients managed during these periods were segregated into Pre-Lockdown (January-2020) and Lockdown (April/May-2020) cohorts. Relevant data were obtained from patients’ electronic medical records and main outcome measures compared between both arms were definitive diagnosis, rate of acute appendicitis, diagnostic imaging modality utilised, management approach and post-operative 30-day complications. Results RIF pain referrals were fewer (17% vs. 23%, P = 0.045) but more likely to be related to acute appendicitis during the lockdown (52% vs. 28%, P = 0.002). However, the risk of presenting with complicated appendicitis did not alter significantly (26% vs. 19%, RR = 1.34, P = 0.56). Diagnostic imaging was increasingly deployed (for RIF pain: 91% vs. 74%, P = 0.07; for appendicitis: 77% vs. 42%, P = 0.007) especially computerised tomography scan (45% vs. 31%). Increased adoption of conservative approach in the management of acute appendicitis was significant (61% vs 23%, RR 2.65, P = 0.01) although other outcomes such as length of stay, post-operative complication and 30-day re-presentation rates were comparable to pre-lockdown phase. Conclusion Fewer RIF pain but more likelihood of acute appendicitis, increased use of radiological imaging and conservative approach to management reflect an evolving pattern during the lockdown phase.

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A comparative study of RIPASA and Alvarado score for the diagnosis of acute appendicitis

International Surgery Journal ◽

10.18203/2349-2902.isj20204930 ◽

2020 ◽

Vol 7 (12) ◽

pp. 4006

Author(s):

Praveena Suresh ◽

Rajan Janardhanan ◽

Deepak Paul

Keyword(s):

Acute Appendicitis ◽

Scoring System ◽

Prospective Observational Study ◽

Iliac Fossa ◽

Scoring Systems ◽

Alvarado Score ◽

Medical College ◽

Right Iliac Fossa Pain ◽

Sensitivity Specificity ◽

Ripasa Score

Background: Acute appendicitis is a common problem and can be difficult to diagnose at time. There are many scoring systems to predict the diagnosis of acute appendicitis. The most commonly used scoring system is Alvarado scoring system but, it is far from perfect. In this study we compare Raja Isteri Pengiran Anak Saleha Appendicitis (RIPASA) scoring system to Alvarado scoring system in correctly diagnosing acute appendicitis.Methods: This prospective observational study was conducted in the department of general surgery, Sree Gokulam Medical College and Research Foundation. It comprised of 60 consecutive patients who were admitted with suspicion of appendicitis who had right iliac fossa pain. RIPASA and Alvarado scoring was done and compared to histopathology after surgery. Sensitivity, specificity and accuracy was calculated.Results: Majority of the patients were below 30 years of age majority were males 36 (60%). When Alvarado score predicted appendicitis in 31 (51.77%) and RIPASA in 54 (90%). When the RIPASA score was >7.5 the sensitivity was 100%, specificity 67% and accuracy was 95%.Conclusions: RIPASA scoring system is more accurate to diagnose acute appendicitis especially when RIPASA score is >7.5. literatures.

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A rare case of Valentino’s syndrome

International Surgery Journal ◽

10.18203/2349-2902.isj20183219 ◽

2018 ◽

Vol 5 (8) ◽

pp. 2933

Author(s):

Mohan C. P. ◽

Kabalimurthy J. ◽

Balamurugan E. ◽

Jayavarmaa R.

Keyword(s):

Acute Appendicitis ◽

Rare Case ◽

Iliac Fossa ◽

Duodenal Perforation ◽

Peptic Ulcer Perforation ◽

Gastric Contents ◽

Right Iliac Fossa Pain ◽

The Right ◽

Clinical Conditions

The pain in the right iliac fossa corresponds with many clinical conditions, most commonly Acute appendicitis. Rarely peptic ulcer perforation presents as pain in the right iliac fossa. This condition is called as Valentino’s syndrome. This is due to the leakage of the gastric contents from the stomach or duodenum during the perforation. This induces peritonitis and sometimes the fluids get collected in the right iliac fossa causing pain, hence mimicking appendicitis. This is the case study of a 17yr old boy with right iliac fossa pain and tenderness, vomiting, fever, all corresponding to acute appendicitis. But on surgical exploration, it was found to be duodenal perforation. Valentino’s syndrome is a very misleading condition which will lead to death if proper evaluation and timely management is not done. This study emphasis the fact that Valentino’s syndrome has to be considered as the differential diagnosis in symptoms suggestive of acute appendicitis.

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Role of Graded Compression Ultrasonography in Evaluation of Acute Appendicitis.

Medical Journal of Shree Birendra Hospital ◽

10.3126/mjsbh.v12i2.12929 ◽

2015 ◽

Vol 12 (2) ◽

pp. 49-53

Author(s):

Mukunda Singh Shrestha ◽

Hom Prasad Pant ◽

Shiv Bahadur Basnet ◽

Govinda Bhahadur Khadka ◽

Rajive Raj Shahi ◽

...

Keyword(s):

Acute Appendicitis ◽

Predictive Value ◽

Iliac Fossa ◽

Clinical Impression ◽

High Morbidity ◽

Emergency Setting ◽

Compression Technique ◽

Suspected Appendicitis ◽

Right Iliac Fossa Pain ◽

Compression Ultrasonography

Introduction: Acute appendicitis is common surgical emergency which can lead to high morbidity and mortalityin absence of timely treatment. Ultrasonography (USG) is commonly used to diagnose appendicitis and excludeother intraabdominal pathology leading to right iliac fossa pain in emergency setting. We aimed to Þ nd out thediagnostic value of graded compression USG in suspected appendicitis cases.Methods: Altogether 107 patients with clinical impression of acute appendicitis were followed. Four caseswere excluded because of other diagnosis established in USG. Appendicitis was diagnosed by standard criteriasof inß ammed appendix by graded compression technique. Informations of 103 cases were recorded in proformawhich was later entered in SPSS and statistical calculations done.Results: Out of 103 cases followed, 93 had appendicitis. Of those, 46 cases only showed inß ammed anddistended appendix, others showed ancillary features only. Males were more affected 61(65.6%) than females.Sensitivity, speciÞ city, positive predictive value, negative predictive value and accuracy of ultrasound indetecting appendicitis were 98.9%,90%,98.9%,90% and 97.1% respectively.Conclusions: Graded compression ultrasonography is good investigation modality in assessement of suspectedacute appendicitis.doi: http://dx.doi.org/10.3126/mjsbh.v12i2.12929

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Diagnostic Value of Interleukin-6 and C-Reactive Protein in Acute Appendicitis

Swiss Surgery ◽

10.1024/1023-9332.6.4.169 ◽

2000 ◽

Vol 6 (4) ◽

pp. 169-172 ◽

Cited By ~ 26

Author(s):

Erkasap ◽

Ates ◽

Ustuner ◽

Sahin ◽

Yilmaz ◽

...

Keyword(s):

Acute Appendicitis ◽

Interleukin 6 ◽

Iliac Fossa ◽

Diagnostic Value ◽

C Reactive Protein ◽

Reactive Protein ◽

Perforated Appendix ◽

Right Iliac Fossa Pain ◽

The Mean ◽

Serum Crp

The aim of this study is prospectively to evaluate the serum C-reactive protein (CRP) and interleukin-6 (IL-6) levels in detection of acute appendicitis in patients with right iliac fossa pain. Data were collected in prospective manner on 102 consecutive patients with right iliac fossa pain. Laparotomy was performed for suspected acute appendicitis for 55 of the 102 patients, of whom 49 patients had appendicitis, 6 patients non-appendicitis (NA), and the other 47 patients had nonspecific abdominal pain (NSAP) and they did not undergo operation. Among those with appendicitis 31 had acute appendix (AA), 8 had gangrenous appendix (GA), and 10 had perforated appendix (PA). The WBC and CRP the mean (SEM) values were significantly different in AA, GA, and PA groups compared with NSAP and NA groups (P < 0.05). Although the mean IL-6 levels were significantly different only in PA group than the others groups (P < 0.05). The sensitivity and specificity of serum CRP measurements were calculated as 96% and 87%, respectively whereas these were 33% and 83% for IL-6 levels for the diagnosis of the acute appendicitis. As a result, measurement of the CRP levels and WBC have an additional diagnostic value on the diagnosis of the acute appendicitis but determination of IL-6 levels which added to the test combination of WBC and CRP, the sensitivity for the diagnosis of the acute appendicitis was not changed whereas the specificity was decreased to 66%.

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A Prospective Audit of 300 Consecutive Young Women with an Acute Presentation of Right Iliac Fossa Pain

Annals of The Royal College of Surgeons of England ◽

10.1308/003588406x94887 ◽

2006 ◽

Vol 88 (2) ◽

pp. 140-143 ◽

Cited By ~ 7

Author(s):

Adam TM Rennie ◽

Matthew G Tytherleigh ◽

Katerina Theodoroupolou ◽

Ridzuan Farouk

Keyword(s):

Acute Appendicitis ◽

Wound Infection ◽

Carcinoid Tumour ◽

Iliac Fossa ◽

District General Hospital ◽

Childbearing Age ◽

Delay In Diagnosis ◽

Child Bearing ◽

Active Observation ◽

Right Iliac Fossa Pain

INTRODUCTION A prospective study of 300 women of child-bearing age presenting with right iliac fossa pain was carried out to determine what proportion had appendicitis and whether active observation resulted in a delay in diagnosis to the detriment of the patient. PATIENTS AND METHODS Data were prospectively collected for 300 consecutive women of childbearing age referred with right iliac fossa pain to general surgeons at a district general hospital. RESULTS After clinical assessment, 71 were discharged home immediately. Two others were found to be pregnant and 4 admitted to gynaecology. The remaining 223 women were admitted to the general surgical unit, 112 of whom underwent immediate appendicectomy. Of these, 97 had acute appendicitis. Two suffered deep infection and two had a superficial wound infection. A further decision to operate was made in 42 of 111 patients admitted for active observation, with 36 having acute appendicitis and 2 having a carcinoid tumour. Four had a wound infection. The average in-patient stay of those admitted for active observation and not operated on was 2 days (range, 1–4 days) compared with a length of stay of 2 days (range, 1–7 days) for those who underwent ‘immediate’ appendicectomy. CONCLUSIONS Most women of child-bearing age who present with right iliac fossa pain do not have appendicitis. Those who do not have the classical features of appendicitis or peritonism can be safely managed by active observation.

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